Innholdsfortegnelse for Volume 1 Issue 2 i Aster Medical Journal (AMJ)

It was on May 2nd 2018 when the first In-dex - Mohammed Sabith - was taken to a Kozhikode Sub divisional hospital and from where he was referred to the Kozhikode Medical College for better care. During the care process in the Casualty, CT room and ICU, the infection spread through direct contact to other people who later succumbed and took the final total death toll to 16. His brother Mohammed Salih who was the second case, was taken to the private Baby Memorial Hospital in the early hours of May 17th with symptoms of encephalitis. Due to the recent history of his brother’s demise from a similar condition about two weeks prior and three other close relatives exhibiting similar symptoms, clinical doubts arose that the treating medical team was…

Dr Emily S Gurley has worked in public health research in Bangladesh since 2003 and spent 12 years at the ICDDR-B (International Center for Diarrheal Diseases Research, Bangladesh) where she led the Surveillance and Outbreak Investigation Unit and served as Director of the Program on Emerging Infections. She worked closely with the US CDC and the Government of Bangladesh to establish national surveil-lance for meningoencephalitis, respiratory infections, acute gastroenteritis, acute hepatitis, and hospital-ac-quired infections, with a focus on developing junior scientists. Dr Gurley leads multi-disciplinary studies on the transmission, burden and epidemiology of a variety of emerging and established diseases, taking into account the ecological context in which human disease occurs. She has been working on describing the ecology and epidemiology of Nipah virus since 2004, including identifying transmission pathways…

Padinhare P. Mohanan, MD, DM; Mark D. Huffman, MD, MPH; Abigail S. Baldridge, MS; Raji Devara-jan, MS; Dimple Kondal, PhD; Lihui Zhao, PhD; Mumtaj Ali, MCA; Johny Joseph, MD, DM; Koshy Eapen, MD, DM; Mangalath N. Krishnan, MD, DM; Jaideep Menon, MD, DM; Manoj Thomas, MD, DM; Donald M. Lloyd-Jones, MD, ScM; Sivadasanpillai Harikrishnan, MD, DM; Dorairaj Prabhakaran, MD, DM, MSc; for the ACS QUIK Investigators KEY POINTS Question What are the costs and risks of impoverishment for patients with acute myocardial infarction and their families in Kerala, India, and how do these factors vary by health insurance status? Findings In this prespecified cross-sectional substudy of a randomized clinical trial, 2114 respondents reported $480 international dollars in out-of-pocket costs per acute myocardial infarction, with $400 international dollars in higher costs…

INTRODUCTION Saphenous vein grafts have been established as the gold standard conduit for lower extremity bypass grafting [1]. Conventionally, the great saphenous vein (GSV) is typically harvested via a long continuous or “skip” incisions that may extend from the groin to the ankle, before its use as an arterial conduit. This approach, however, is associated with significant morbidities, including surgical site infections, ischemic skin flaps, fat necrosis, lymph leaks, increased postoperative pain, and longer hospital length of stay (LOS) for as many as 24% to 43% of patients [2].Endoscopic vein harvest (EVH) has been demonstrated to improve early morbidity when compared with the conventional open harvest technique (OVH) for infrainguinal bypass surgery. The aim of this article is to report a simple but unique technique to tunnel the vein graft…

INTRODUCTION Nipah virus (NiV) is a Para-myxovirus that has recently been responsible for outbreaks in India. In 2018, it caused an outbreak in Kozhikode that resulted in 17 deaths. This year, it has again resurfaced in Kerala. The index case was identified in the Department of Neurology at Aster Medcity, Kochi, Kerala. Due to early detection, isolation and containment measures initiated by all of the involved depart-ments, there were no further cases identified. A number of close family members, close con-tacts and nursing personnel were placed under observation or isolation in the nearby Cochin Medical College, Nipah isolation ward. Repeated sampling of suspected cases did not disclose any further infections and the infection was contained at ‘Patient Zero’. In this article, we discuss the clinical presentation of the index case.…

The discovery of penicillin by Alexander Fleming in 1928 is often portrayed as a stroke of serendipity falling upon a sloppy worker who had left a bacterial culture plate open on his bench while taking a holiday. The fungus that landed there killed the bacteria – and the lucky Fleming could claim to have saved the world. It was no simple fluke. The Scottish doctor had, in fact, been leading research into the quest for antimicrobial agents for many years by this time. Fleming, however, failed to develop the drug, finding it too difficult to purify. This was left to Howard Florey, Ernst Chain and Norman Heatley in Oxford over a decade later – work catalysed by the necessity of war. The first patient to be treated with penicillin was…

IT WAS A BALMY SUNDAY EVENING IN EARLY 1999, AND DR. KAW BING CHUA HADN’T HAD LUNCH OR DINNER. THERE WASN’T TIME TO EAT. CHUA WAS CHASING A KILLER. AND HE THOUGHT MAYBE HE HAD FINALLY TRACKED IT DOWN. HE SLID THE SLIDE UNDER THE MICROSCOPE LENS, TURNED ON THE SCOPE’S LIGHT AND LOOKED INSIDE. “A CHILL WENT DOWN MY SPINE,” CHUA SAYS. “THE SLIDE LIT UP BRIGHT GREEN, LIKE BRIGHT GREEN LANTERNS.” Right there, in Chua’s hands, was a virus the world had never seen before. And as he soon learned, it’s also one of the most dangerous ones. Now Chua had enough of the virus to kill everyone in the lab. Maybe worse. The new virus — eventually called Nipah — is on the World Health Organization’s list…

Dr G Arunkumar, Director of Manipal Institute of Virology, was the scientist at the forefront of the identification and diagnosis of NiV in the 2018 outbreak in Kerala, India. For the first time in India, Arunkumar and his team at Manipal Institute of Virology detected the virus using Real-time PCR. The eminent virologist, who has been part of the myriad of encephalitis outbreak investigations in India talks to Aster Medical Journal. AMJ: Rapid Detection of Nipah Virus helped to contain the out-break in Kerala. As the first person to detect the Nipah virus in India, could you please tell us what made you test for Nipah? Dr Arunkumar: For the past few years, we have been conducting a study to understand the etiology of hospitalised febrile illness cases in rural…

Organ transplantation stands out as an epitome of the potential of scientific progress in alleviating human suffering. In equal measure, it is also emblem-atic of the ethical challenges involved in the process of complex medical decision making. The guiding principles of medical ethics autonomy, beneficence and non-maleficence find prominent expression in the area of living donor organ transplantation. Respect for autonomy dictates that health care professionals should yield to the decision making capabilities of individuals as autonomous agents, Beneficence prescribes that decisions taken after balancing the risks and benefits should always benefit the patient, and non-maleficence encodes the idea of primum non nocere, that harm disproportion-ate to the benefit of treatment should be avoided 1. Beneficence to the recipient is the foundation on which the entire edifice of transplantation stands.…

In Vietnam, another public health scare bubbled up this spring, when WHO reported that an Australian tourist had been diagnosed with Zika virus after vacationing in the country. But as Facebook rumours began to swirl, the health ministry’s information chief, Nguyen Dinh Anh, began posting international news stories on his Facebook page and explaining what Vietnam was doing to prepare for a possible outbreak. Hoang, of VnExpress, says the health minister’s Facebook page is still relatively sparse, and should be updated and managed by a professional. But the information chief’s response to Zika, he adds, seems to show that the ministry has at least recognised the importance of being transparent about public health risks and engaging the Vietnamese public on social media. This time around, “they’re posting on their own,…

Like many nephrologists, Dr Unni was drawn to nephrology by a duty of patient care after four years of general practise, on seeing “the difficulties faced by patients on dialysis”. There can be few transformations more dramatic than that of patient recovery following transplant, of which Dr Narayanan has witnessed many, having conducted more than 1100 transplant procedures over the course of a 34 year career. Prior to specialising in trans-plantation, Dr Unni‘s career path-way began in India, leading him to the Christian Medical College, Vellore and to the P.G.I. Chandigarh, both centres of excellence for renal transplantation in India; here, he lectured students as well as dealt with the demands of the busy casualty and intensive care units. Dr Unni was an exceptional student, and was awarded both the…

JAMA Neurology May 20th 2019 Association Between Unrecognized Myocardial Infarction and Cerebral Infarction on Magnetic Resonance Imaging This is a cross-sectional subcohort study involving 925 patients from the ICELAND MI registryto determine whether unrecognized MI detected by cardiac magnetic resonance imaging (MRI) is associated with cerebral infarction. Five enrolled participants had nondiagnostic brain MRI studies and were excluded. Among 925 participants, 480 (51.9%) were women; the mean (SD) age was 75.9 (5.3) years. There were 221 participants (23.9%) with cardiac MRI evidence of MI, of whom 68 had recognized MI and 153 unrecognized MI. There were 308 participants (33.3%) with brain MRI evidence of cerebral infarction; 93 (10.0%) had embolic infarcts of undetermined source. After adjustment for demographic factors and vascular risk factors, the likelihood (odds ratio) of having cerebral…

The young man shifts nervously in the front seat of the van as it turns down increasingly narrow roads, then alleyways, and eventually dirt tracks. His broad grin and swagger have faded since he first volunteered to lead us to the home of a local gachhi, a collector and seller of date palm sap. Leaning out the open window, he asks for directions from three men standing over the parts of a disassembled engine scattered on a dusty concrete floor, then from a man butchering chickens on a wood block out front of a roadside stand. Whether our guide’s waning confidence is due to the fact that he doesn’t know the area as well as he first let on, or because revealing a local secret to a vanload of outsiders…

1 Specialist - Nephrology, Department of Nephrology, Aster Hospital Dubai, UAE. 2 Specialist - Nephrology, Department of Nephrology, Aster Hospital, Dubai, UAE. 3 Consultant Biostatistician - Digital Greenhouse, St Peterport, Guernsey 4 Specialist - Pathology, Department of Laboratory Medicine, Aster Hospital Dubai, UAE. Correspondence Dr Manu Gopala Krishnan, Specialist, Department Of Nephrology, Aster Hospital, Dubai, UAE, 9 A Street, Al Qusais, Dubai – United Arab Emirates E: manu.gopalakrishnan@asterhospital.com T: +971 4 4 400 500 Funding information This study was funded by Aster Hospital Dubai. ABSTRACT There is limited data available about the prevalence of chronic kidney disease (CKD) and its risk factors in the general population of The United Arab Emirates (UAE). To estimate the prevalence of CKD and its associated risk factors in the UAE, which has a predominately…

THE INITIAL PREOCCUPATION WITH JAPANESE ENCEPHALITIS The outbreak of Nipah virus was a tragic event for the people of Malaysia especially for those in the pig-farming industries.1 Though, officially the outbreak was recorded as starting in September 1998 in the northern part of peninsular Malaysia, the virus had most likely spilled into the swine population as early as 1997.2 This was substantiated with a finding of 6 encephalitis patients who were admitted to Ipoh General Hospital in 1997 and whose stored sera were found to have anti-Nipah virus IgG.3 The outbreak of febrile encephalitis in humans was preceded by the occurrence of respiratory illness and encephalitis in pigs in the same region. Unusual deaths in pig population were reported by pig farmers to veterinary officers in Veterinary Research Institute, but…

In the spring of 2014, Vietnam’s state-controlled news media reported that dozens of children had died after turning up at hospitals in the capital, Hanoi, with rashes and high fevers. Doctors said the cause was a measles outbreak – the worst in Vietnamese history. Parents of victims rushed onto Facebook to share their grief and outrage. So did their friends and neighbours, who wanted to know how the outbreak was spreading, and whether it was even safe to take children to hospital. The authorities distributed information about the measles deaths via leaflets, loudspeaker bulletins and updates on the health ministry’s website, recalls a nurse at a state-run hospital in Hanoi, who requested anonymity in order to speak frankly. “But there was so much information online that some people became panicked.”…

ABSTRACT Amniotic Band Syndrome is a series of congenital malformations ranging from minor constriction rings to complex multiple congenital anomalies, that are attributed to amniotic bands that entangle and disrupt foetal parts. While mild variants have a good prognosis with normal life expectancy, severe cases may be incompatible with life. We report a case of a 20 week old foetus with an amniotic band around the right upper limb, entanglement around the neck and a Congenital Talipus Equinovarus deformity of the right foot, delivered from a 31 year old female patient, who came for a routine check up to the Department of Obstetrics and Gynecology at DM Wayanad Institute of Medical Sciences, Meppadi post, Kerala. Early prenatal diagnosis of this defect by Ultrasonography is a boon to Obstetricians, Pediatricians and…

Fetus-in-fetu (FIF) is an extremely rare developmental abnormality with an incidence of 1 in 500 000 births.it was first reported in 1808 by George Young. Since then, less than 200 cases have been reported worldwide. FIF is characterized by the incorporation of one or more partially-developed fetuses into the body of an otherwise normally developed fetus and most commonly presents with a mass in the abdomen. In this case, a 5 days old infant was referred from a neighbouring hospital to Aster MIMS Kottakkal, Kerala, India for scanning of an abdominal mass. During the ultrasound, a cystic structure with calcified limb-like structures within it was found. It resembled a fetal limb, near to the liver and kidneys of the neonate. Further, a 3D & 4D scan was performed, and the…

Lissa: A Story About Medical Promise, Friendship, And Revolution Written By: Sherine Hamdy & Coleman Nye Art By: Sarula Bao & Caroline Brewer As young girls in Cairo, Anna and Layla strike up a friendship that crosses class, cultural, and religious divides. Years later, Anna learns that she may carry the hereditary cancer gene responsible for her mother’s death. Meanwhile, Layla’s family is faced with a difficult decision about kidney transplantation. Their friendship is put to the test when these medical crises reveal stark differences in their perspectives. Anna is the daughter of an expat American oil family living in Cairo, and Layla, her Egyptian friend, is the daughter of the apartment building’s bawab, or caretaker. The book opens with Anna’s mother, is diagnosed with, battles against, and succumbs to…