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Doctors amputate teen’s legs & fingers as gangrene sets in after eating leftover restaurant takeaways

by Medically Speaking February 23, 2022

written by Medically Speaking

A adolescent who had missed his meningococcal vaccine booster shots contracted the disease and was only able to survive a near-fatal bout of food poisoning after physicians amputated his gangrenous legs and fingers because sepsis had struck in quickly.

The details of the case’s findings were first published in The New England Journal of Medicine in March 2021, but they went viral after a popular Youtuber doctor named Bernard Hsu, who runs the Chubbyemu channel, posted an explainer video on the website.

Not all leftovers are bad, and this was indeed just a freak accident that happened in a perfect storm sequence of events, explains Dr Bernard Hsu who says he too eats recycled (reheated) leftovers regularly.

What caused the serious food poisoning and sepsis?
The 19-year-old student ate some leftover chicken and rice noodles that his friend had left in his fridge, which triggered a potentially deadly disease. According to this study, a patient was admitted to the paediatric intensive care centre (PICU) “because of shock, multiple organ failure, and rash”. His pain first started 20 hours before he was admitted and shortly after he “ate rice, chicken, and lo mein leftovers from a restaurant”.

As noted in Hsu’s video, this patient, who is referred to as JC, was finally treated at the Massachusetts General Hospital in the US.

But when he ate the noodles and suffered a severe vomitting spell, he had initially been taken to a local hospital by his friend the next morning. The patient had a fever, high blood pressure, and pale skin. After JC vomited, doctors noticed a “greenish-yellow colour, not looking like any particular kind of food”.

Soon his blood pressure dropped, his breathing became laboured, and the oxygen level dropped. His body developed a mottled rash that appeared like some bruises, but then they became a deep reddish-brown, red defined at the edges. It was then as he got sicker that the youth was transported via helicopter to the bigger better-equipped hospital. He was put on oxygen support. Luckily, his brain did not seem to have been affected.

Following more blood and urine tests, JC was diagnosed with Neisseria meningitides, which caused his stiff neck, nausea, respiratory collapse, shock, and multiorgan failure.

Diagnosis? Meningococcal disease with purpura fulminans:
According to the Australian government’s Health website, “Meningococcal disease is contagious. It is transmitted through close and prolonged contact with mucus from an infected person. Symptoms include a rash and fever. Meningococcal can affect people of all ages but can be prevented with vaccination. Meningococcal disease is treated with antibiotics.” According to Dr Bernard Hsu, the patient had been given a Meningococcal vaccine in his middle school years but had missed the two booster shots he was to take at age 16 and when he entered university.

According to Science Direct, “Purpura fulminans (PF) is a unique and devastating thrombotic disorder, often acute and fatal, that manifests as large irregular areas of blue-black cutaneous bleeding that rapidly progress to necrosis of superficial skin and deeper soft tissues.”

Luckily, the patient made full recovery from the infection after a few weeks though the amputation left him with other health issues to deal with for the rest of his life.

February 23, 2022 0 comment

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Freebies to doctors to increase drug sales are illegal, and businesses can’t claim IT deduction: SC

by Medically Speaking February 23, 2022

written by Medically Speaking

The Supreme Court ruled on Tuesday that pharmaceutical corporations giving freebies to doctors to increase drug sales is “obviously banned by law,” dismissing a company’s request for a deduction under the Income Tax Act for giving incentives to doctors.

The top court termed as a matter of great public importance and concern the manipulation of doctors’ prescriptions in lieu of freebies offered to them by pharmaceutical companies, ranging from gifts such as gold coins, fridges, and LCD TVs to funding international trips for vacations or to attend medical conferences.

A bench comprising justices U U Lalit and S Ravindra Bhat dismissed the appeal of M/s Apex Laboratories Pvt. Ltd against the order of the high court and in the verdict, it also dealt with a tricky legal issue where tax deduction on account of granting freebies to doctors was claimed saying though medical practitioners are restrained under the regulations from accepting such gifts, it was not an offence under any law and hence, companies are entitled to the tax benefit.

Analysing the law and regulations concerned, the verdict, penned by Justice Bhat, said, pharmaceutical companies’ gifting freebies to doctors, etc. is clearly prohibited by law’, and not allowed to be claimed as a deduction under Section 37(1). Doing so would wholly undermine public policy. The well-established principle of interpretation of taxing statutes that they need to be interpreted strictly cannot sustain when it results in an absurdity contrary to the intentions of Parliament.

Deprecating the practice of giving freebies, the bench said medical practitioners have a quasi-fiduciary relationship with their patients and their prescriptions are considered the final word on the medication to be availed by the patient, even if the cost of such medication is unaffordable or barely within the economic reach of the patient such is the level of the trust reposed in doctors. These freebies are technically not free’ the cost of supplying such freebies is usually factored into the drug, driving prices up, thus creating a perpetual publicly injurious cycle. The threat of prescribing medication that is significantly marked up, over effective generic counterparts …, it said and referred to reports on the issue.

The firm, in its appeal, said the amended 2002 Regulations for doctors did not apply to pharmaceutical companies. While medical practitioners were expressly prohibited from accepting freebies, no corresponding prohibition in the form of any binding norm was imposed on the pharmaceutical companies gifting them, and in the absence of any express prohibition by law, it could not be denied the benefit of seeking exclusion of the expenditure incurred on supply of such freebies under Section 37(1) of the IT Act.

Under the provision, any expenditure, such as payment of hapta’, freebies, donations, protection, or extortion money will not be allowed as a deduction. This court is of the opinion that such a narrow interpretation of Explanation 1 to Section 37(1) defeats the purpose for which it was inserted, i.e., to disallow an assessee from claiming a tax benefit for its participation in an illegal activity, the judgement said.

It is also a settled principle of law that no court will lend its aid to a party that roots its cause of action in an immoral or illegal act meaning that none should be allowed to profit from any wrongdoing coupled with the fact that statutory regimes should be coherent and not self-defeating, it said. Doctors and pharmacists being complementary and supplementary to each other in the medical profession, a comprehensive view must be adopted to regulate their conduct in view of the contemporary statutory regimes and regulations.

Therefore, denial of the tax benefit cannot be construed as penalizing the assessee pharmaceutical company. Only its participation in what is plainly an action prohibited by law precludes the assessee from claiming it as a deductible expenditure, it said.

The company’s incentives in this case had the direct result of exposing the recipients to the odium of sanctions, resulting in a ban on their practise of medicine, according to the report. A notice was issued to the company in response to the IT circular, asking why a total of Rs 4.7 crore was spent on gifting freebies to medical practitioners such as hospitality, conference fees, gold coins, LCD TVs, fridges, laptops, and other items to raise awareness about the health supplement Zincovit’ and why it should not be added back to the company’s total income.

February 23, 2022 0 comment

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At Delhi hospital, American woman treated for rare tissue infection in eye

by Medically Speaking February 23, 2022

written by Medically Speaking

At a Delhi hospital, an American woman was treated for a rare tissue infection in her eye. 21 February, New Delhi (PTI) According to hospital officials, an American woman who had recently visited the Amazon rainforests was diagnosed with an uncommon case of myiasis, a form of tissue infection, in her eye and underwent “successful surgery” at a private clinic here.

“Three live human botflies over 2 cm in size” were extracted from the 32-year-old woman during the operation, they claimed.

Myiasis is the infection of a fly larva (maggot) in human tissue. This occurs in tropical and subtropical areas The patient visited the emergency department with complaints of swelling in the right upper eyelid along with redness and tenderness.

She also revealed that she had been feeling something moving inside her eyelids once in a while for the past 4-6 weeks, Fortis hospital, Vasant Kunj, said in a statement.

She had consulted doctors in the US, but the myiasis (botfly) could not be removed and doctors discharged her on few symptomatic relief medications, it said.

Dr Mohammad Nadeem, consultant and head

emergency department, at the hospital, said, “It was a very rare case of myiasis. Therefore, these cases need to be evaluated in detail urgently”.

“The US national is a traveller and had a history of visiting the Amazon jungle two months back. Suspecting foreign body from her history of travelling, and noticing movements inside her skin, diagnosis was done,” he said.

Dr Narola Yanger from the surgery department proactively managed to remove “three live human botflies almost of 2 cm in size — one from the right upper eyelid, second one from back of her neck and third from her right forearm,” the statement said.

The surgery was completed in 10-15 minutes with all aseptic precautions, without any anesthesia. The woman was discharged on symptomatic prescribed medicines from the emergency department, it said.

Myiasis burrow into delicate membranes and feed on underlying structures. Such cases have been reported earlier too from tropical and subtropical areas like Central and South Americas and Africa, the statement said.

In India, such cases have been reported mostly from rural areas particularly in children where the botflies have entered through either nasal opening or musculoskeletal skin lesions, it claimed.

Had the yiasis not been removed, it could have caused considerable destruction of tissues, resulting in complications such as extensive erosion of nose, face, and orbit. This could have led to rare meningitis and death, doctors claimed.

February 23, 2022 0 comment

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Newborn dies, woman delivers on hospital floor as staff insists on paperwork in Saharanpur

by Medically Speaking February 23, 2022

written by Medically Speaking

Nanauta: In a horrific occurrence reported from Uttar Pradesh’s Saharanpur district, a pregnant mother delivered her baby on the hospital floor, resulting in the newborn’s death. The woman’s health is thought to be critical.

Following the death of the newborn, the woman’s relatives raised a ruckus. The tragedy has been blamed on medical malpractice by the relatives.

Police were called to the hospital afterwards and were able to calm down the upset relatives. According to a report in the Hindi daily Hindustan, the incident occurred in the district’s Nanauta area.

The Community Health Centre (CHC) received a pregnant woman from Mohalla Sheikhzadaan for birth. The woman’s family wanted a diagnostic report from the CHC personnel when they inquired.

The woman then sat on the floor and went into a labour pain. The woman then delivered the baby who died on the spot.

In a similar incident reported from January 2020, a woman was forced to deliver on the floor of Dr Mathra Das Pahwa Civil Hospital in Moga district of Punjab. The incident took place when the health staff refused to attend to the woman saying she wasn’t yet prepared for the delivery.

The woman’s family claimed not a single doctor was available on night duty when the woman was taken to the hospital. They alleged that one nurse and two helpers including a class-IV employee were attending the pregnant woman, according to a report in Indian Express.

February 23, 2022 0 comment

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WHO said, Omicron Variant No More Severe Than Original Strain

by Medically Speaking February 23, 2022

written by Medically Speaking

The BA.2 version of the Omicron coronavirus strain is not more dangerous than the original, according to the World Health Organization.
“We are not seeing a difference in severity of BA.1 compared to BA.2,” Maria Van Kerkhove, a senior WHO official, said in an online question and answer session based on a sample of people from various nations.

“As far as the risk of hospitalisation is concerned, this is a similar level of severity. And this is critical because both BA.1 and BA.2 have had a lot of circulation in various countries “she stated.

Van Kerkhove, who leads the technical side of the WHO’s Covid-19 response team, was reporting the findings of a committee of experts tracking the evolution of the virus.

Their conclusions will come as a relief to countries such as Denmark, where the BA.2 variant of Omicron has circulated widely.

The WHO said in a statement that initial data suggests the new BA2 variant “appears inherently more transmissible than BA.1,” and that further studies are ongoing to discover why this is the case.

“However the global circulation of all variants is reportedly declining,” it added.

Coronavirus has killed more than 5.8 million people worldwide, according to an AFP tally compiled from official sources on Tuesday.

Taking into account excess mortality linked to Covid-19, the WHO estimates the true death toll could be two to three times higher.

February 23, 2022 0 comment

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34-Year-Old Woman was saved by First-In-The-World Medical Interventions In Kidney Transplant

by Medically Speaking February 23, 2022

written by Medically Speaking

Dr. Madan Bahadur, Director, Department of Nephrology and Kidney Transplantation, has published a first-in-the-world medical research that found life-threatening antiviral side effects in patients with a genetic defect that is frequent among Indian transplant patients. This research was carried out at Jaslok Hospital and Research Centre, which is the pioneer of kidney and liver transplantation in western India.

Following a kidney transplant, valganciclovir is commonly administered to prevent viral infection. Patients with NUDT15 enzyme deficiency have severely low blood counts after using valganciclovir, according to Dr Ashay Shingare, Consultant Nephrologist at Jaslok Hospital, making them exposed to life-threatening infections.

In one recent kidney transplant recipient, a genetic test revealed NUDT15 deficiency, and after quitting valganciclovir, his blood numbers improved, and the infection went away.

First Case Of To Find The Link Between Valganciclovir And Genetic Variation

The prominent transplant journal Transplant Infectious Disease has published the first case report of a link between valganciclovir and genetic variation. In the instance of Mahima Ralli, 34, who was hospitalised to the ICU in January 2022 with a urinary tract infection following a kidney transplant, this genetic association report saved her life.

Mahima was diagnosed with the renal illness in 2002 and began hemodialysis in 2004. She was taken to Jaslok Hospital’s ICU after experiencing a dramatic rise in her blood pressure that was uncontrollable despite seven blood pressure medications and the removal of both of her damaged kidneys. She was given a combination of sodium nitroprusside and sildenafil for blood pressure control, which was a new, first-in-the-world intervention that saved her life.

Patients Got A Kidney Transplant A Second Time

Later that year, in 2004, she received a living donor kidney transplant from her mother, which has been functioning successfully for more than 16 years. Her kidney function deteriorated as a result of urinary bladder difficulties, and she was forced to return on dialysis in 2021. Mahima’s maternal aunt gave her kidney to her for a second kidney transplant at Jaslok Hospital in November 2021.

A new urinary bladder was surgically built prior to the donation. Because the blood types of the donor and recipient did not match, she underwent plasmapheresis operations. She got an extremely low blood count two months after the transplant, which led to a bacterial infection that necessitated ICU care.

Mahima also has a deficit of the enzyme NUDT15, according to genotyping research. She improved after the antiviral was stopped, and she was discharged from the hospital. It’s a miracle that this young child lived to see another day at Jaslok Hospital, where she received unique, first-in-the-world medical treatment.

February 23, 2022 0 comment

Kids Uncategorized

Infant suffers cardiac arrest, post-Covid multi-organ failure; dialysis, CPR saves life

by Medically Speaking Team February 22, 2022

written by Medically Speaking Team

Rahul (name changed) was two years old when he developed a high fever and breathing problems. His parents had no idea how serious the situation was. The baby was transported to a hospital in New Delhi, but he went into cardiac arrest minutes later and could only be revived after 30 minutes of cardiopulmonary resuscitation (CPR).

“Within minutes of arriving at the hospital, the child suffered a cardiac arrest. It was especially disturbing for me as a doctor because he is just two years old. Examinations revealed that he had developed Multisystem Inflammatory Syndrome in Children (MIS-C), a rare disorder in which his own body was trying to kill multiple organs. As a result, the lungs, heart, brain and kidneys had suffered considerable damage,” said Dr Sayed Mustafa Hasan, a senior doctor at the hospital.

“The baby was unable to pass even urine, resulting in a severe condition. He was also experiencing speech difficulty and loss of eye contact with others as a result of the post-Covid effects. We immediately began Continuous Renal Replacement Therapy (CRRT) after reviving him with CPR. The CRRT removed all waste from his body. The therapy continued non-stop for 60 hours. To eliminate infections, we employed the cytosorb dialysis filter. We also worked to normalise his blood pressure,” he added.

Rahul spent 15-16 days on a ventilator in the ICU. During this time, a team of specialists attempted to restore his kidneys, heart and lungs to normal function. Along with CRRT, he was also given hemodialysis and perinoteal dialysis to remove the infection. His condition improved over time, and he was eventually discharged from the hospital.

“Rahul’s heart, lungs and kidneys were not functioning when he was brought to us. It took a massive effort by several paediatric specialities across the hospital to save the child’s life. We used a variety of technologies to keep track of the health of various organs,” said Neha Bhandari, a senior paediatrician at the hospital.

“It was a very rare case and less than 1% of kids suffer from such severe infection, leading to multiple organ dysfunction. Finally, he is rid of all infections and he can resume his normal life,” she said.

A sudden cardiac arrest is rare in children, but the possibility exists. Hence, all children need regular medical check-ups. These can help identify risks that may develop into life-threatening situations. Major hospitals in India have seen cases when children, who had healed from Covid, developed life-threatening post-Covid complications,” said Dr Sameer Punia, another senior doctor at the hospital.

“We lost all hope when we learned that Rahul had suffered a cardiac arrest. I urge other parents to go for regular check-ups of their kids to avoid such situations,” Rahul’s mother said.

February 22, 2022 0 comment

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Stimulants produced in India and Covid medicines are most common illegal imports in Switzerland

by Medically Speaking February 22, 2022

written by Medically Speaking

A substantial quantity of illegally imported drugs from India have been discovered in Switzerland, including medicines linked to the COVID-19 epidemic, such as ivermectin and hydroxychloroquine, as well as sexual stimulants, according to a Swiss government agency.

The Swiss Agency for Therapeutic Drugs (Swissmedic) revealed in its annual report that it and customs authorities confiscated 9,421 parcels containing unlawfully imported pharmaceutical products in 2021, up from 6,733 such packages in 2020.

The majority of the products seized were potency preparations and accounted for around 77 per cent of the confiscated packages. Other preparations secured included prescription-only medicines, such as hormones and anti-inflammatories (17 per cent) or sleeping tablets and tranquillisers (5 per cent).

Around 150 of the packages that were seized were connected with the COVID-19 pandemic. These contained prohibited quantities of prescription-only medicinal products, including anti-parasitics containing ivermectin, medicinal products containing hydroxychloroquine or antibiotics from India.

Swissmedic said Poland has overtaken the countries of Asia to become the first European country to top the country-of-origin rankings.

However, the contents of the packages of potency preparations from Poland that were seized were all erectile stimulants manufactured in India. Swissmedic suspects that new illegal distribution channels have been set up after the authorities successfully shut down the transit route via Singapore in October 2020 as part of an internationally coordinated operation.

India directly accounted for 12 per cent of total seized packages, down from 20 per cent in 2022 and from 43 per cent in 2019.

“Half of the illegally sold preparations do not contain what they claim to contain! Taking medicinal products that have been ordered without a prescription or with a sham online prescription is dangerous to health,” Swissmedic said.

February 22, 2022 0 comment

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No severe disease in country due to Omicron: NCDC

by Medically Speaking February 22, 2022

written by Medically Speaking

SCIENTISTS WATCHING THE BA.2 lineage of the Omicron variety, which is the most common in the country, are also looking into the clinical link between this variant and hospitalizations.

While this sub-lineage has taken the place of the Delta variety, preliminary findings suggest that it may cause death in some individuals. The Centre had started investigations in ten labs to see if there was a link between Omicron’s BA.2 sub-lineage and hospitalizations.

Institutions like AIIMS-New Delhi, Lok Nayak hospital, IGIMS-Patna, NIBMG-Kolkata, CMC-Vellore, Gandhi Medical College-Secunderabad, Kasturba Hospital for Infectious Diseases-Mumbai and B J Medical College-Pune have been involved in these studies.

“While more data is being collected to further understand how clinical markers of severity such as the use of oxygen, mechanical ventilation and deaths are associated with the Omicron variant, preliminary findings do show that Omicron can be fatal in some people. The severity also increases with age and in presence of underlying medical conditions,” medical experts claimed.

For instance, at one hospital around 86 hospitalised patients infected with the Omicron variant were studied apart from five deaths that were due to Omicron.

Recently, the World Health Organisation (WHO) while stressing the importance of vaccination, social distancing, avoiding crowds and wearing well-fitted masks had in its tweet cautioned that infection caused by the Omicron variant can be mild or serious and for some people, the symptoms can also lead to death.

The BA.2 sub-variant of Omicron has been detected in Denmark, the UK and now accounts for approximately one in five new Omicron cases recorded across the world, WHO said.

Dr Sujit Singh, Director, National Centre for Disease Control (NCDC) told The Indian Express that there is no severity as far as BA.1 or BA.2 sub-variant is concerned. “We have detected BA.2 in more than 80 per cent of the samples that were sequenced last month. However, we are seeing an increase in daily discharges at hospitals and the number of new admissions are also decreasing. So, there is reason to believe it is not causing severe disease in India…,” Dr Singh said.

In Maharashtra, an analysis of Covid deaths is underway. “There have been incidental deaths and the cause has to be ascertained,” an official said. Maharashtra, which has had a high number of infections, is on alert and is also stepping up genome sequencing of Covid samples. “Omicron has caused deaths. The BA.2 lineage could have different presentations. Experience in some countries has not been good and we are on alert,” Dr Pradeep Vyas, State Additional Chief Secretary (Health) told The Indian Express.

Overall, more than 11 lakh new Covid-19 infections were reported in the last two months. The mortality rate from December 15 to date, however, has been about 0.1 per cent. According to a state health department analysis in Maharashtra from January till mid-February, there have been 1,690 deaths. Of the 1,690 deaths, 470 were in the 71-80 age group while 378 were in the 61-70 age group. Another 277 deaths were in the 81-90 age group.

Dr Shashank Joshi, an expert member of the state’s Covid-19 task force said that neither the BA.1 nor BA.2 Omicron sub-lineages have shown any sinister potential and the Omicron wave is currently receding. “We did have mortality in some vulnerable and immuno-compromised groups but otherwise there is no reason for panic…,” Dr Joshi said.

February 22, 2022 0 comment

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Genetic code inherited from Neanderthals increases severe Covid risk but protects from HIV

by Medically Speaking Team February 22, 2022

written by Medically Speaking Team

According to a new study, a portion of Neanderthal genetic code that was previously associated to a greater risk of severe Covid illness now protects people from HIV.

Neanderthals were a prehistoric human species that existed in Eurasia until roughly 40,000 years ago.

Hugo Zeberg and Svante Pääbo at Max Planck Institute for Evolutionary Anthropology in Germany have been studying the piece of genetic code since 2020. They found that a part of genetic code in chromosome 3, that made us more susceptible to severe Covid, had been inherited from the Neanderthals more than 50,000 years ago.

Chromosomes are thread-like structures located inside the nucleus of cells. Each chromosome is made of protein and a single molecule of deoxyribonucleic acid (DNA). The DNA contains the specific instructions or genetic code that makes each individual unique.

Humans have 23 pairs of chromosomes. People normally have two copies of each chromosome.

In a study published in The New England Journal of Medicine in October 2020, researchers had found a strong link between severe Covid-19 and two genomic regions: one region on chromosome 3 containing six genes, and one region on chromosome 9 that determines the ABO blood group.

Chromosome 3 spans almost 200 million base pairs or “letters”, and represents about 6.5 per cent of the total DNA in cells. Researchers found that a unique combination of about 50,000 base pairs in chromosome 3 puts people at risk of severe Covid-19.

The gene in issue is carried by 30% of the South Asian population, whereas it is nearly non-existent in Africans.

The researchers from the Max Planck Institute for Evolutionary Anthropology discovered that the DNA sequence that puts people at risk of severe Covid-19 is the same as that found in a Neanderthal who lived more than 50,000 years ago in Croatia.

Later, the scientists discovered that the frequency of DNA has grown considerably since the previous ice age. In fact, a Neanderthal-inherited genetic variation has grown surprisingly frequent.

What puzzled the scientists is that a gene that make humans susceptible to a disease should not survive thousands of years of evolution. The only reasonable explanation to that is that this piece of DNA coding had a favourable impact that the scientists did not know of.

“This major genetic risk factor for COVID-19 is so common that I started wondering whether it might actually be good for something, such as providing protection against another infectious disease,” Zeberg said in a statement.

The genetic risk factor is located in a region on chromosome 3 that consists of many genes. There are several genes in its vicinity that encode receptors in the immune system.

One of these receptors — CCR5 — is used by the HIV virus to infect white blood cells.

With inputs from The Print.

February 22, 2022 0 comment

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