The first Indian Ebola patient can be a potential cure for a future patient

New Delhi, November 22nd, 2014: The use of whole blood or serum from convalescent Ebola virus disease survivors is being used for the treatment of affected patients.

The World Health Organization has issued interim guidance for the collection and administration of convalescent whole blood or plasma for treatment of Ebola virus disease (EVD).

“The patient who is currently undergoing convalescence from Ebola should be persuaded to donate blood or plasma for a future patient”, said Padma Shri, National Science Communication and Dr. B C Roy National Awardee Dr. K K Aggarwal President Heart Care Foundation of India and Senior National Vice President Indian Medical Association.

Giving his valuable insights on the deadly virus Dr. Aggarwal said, "While there is no proven treatment available for Ebola virus disease, whole blood collected from patients in the convalescent phase of infection has been used as an empirical treatment with promising results in a small group of cases with Ebola virus disease and the concept that this treatment could be efficacious is biologically plausible, as convalescent plasma has been used successfully for the treatment of a variety of infectious agents".

 WHO guidelines cover all aspects of this procedure. Patients who have recovered from EVD and been discharged from Ebola treatment centers or units could be potential donors for convalescent whole blood or plasma from 28 days after their day of discharge.
Only those EVD patients who have been discharged according to the WHO criteria as clinically asymptomatic and have twice tested negative for EBOV RNA by molecular techniques, should be considered as potential donors.  The two samples for EBOV RNA testing should be taken at least 48 hours apart, and the test results should be negative on each sample.

Donated convalescent whole blood should be stored between +2 degree and +6 degree (never frozen) preferably in a separate blood bank refrigerator dedicated to convalescent whole blood or plasma units, fitted with a temperature monitoring system and alarm. Plasma separated from whole blood donations or collected by apheresis may be stored as ‘Liquid Plasma’ between +2 degree and six degree in blood bank refrigerators for up to 40 days. Alternatively, it may be frozen either within 8 hours of collection as ‘Fresh Frozen Plasma’ or within 18-24 hours of collection as ‘Plasma Frozen within 24 hours’ and stored for up to 12 months at or below -18 degree.

Only patients with confirmed EVD preferably in its early stages should be considered for transfusion, as an empirical treatment for EVD. ABO and RhD matched blood or plasma units that need to be selected for transfusion.

 
About HCFI

Initiated in 1986, the Heart Care Foundation of India is a leading National NGO working in the field of creating mass health awareness among people from all walks of life and providing solutions for India’s everyday healthcare needs. The NGO uses consumer based entertainment modules to impart health education and increase awareness amongst people. A leading example of this is the Perfect Health Mela, an annual event started in 1993 that is attended by over 2-3 lakh people each year. The Mela showcases activities across categories such as health education seminars and checkups, entertainment programs, lifestyle exhibitions, lectures, workshops and competitions. In addition to this, the NGO conducts programs and camps to train people on the technique of hands only CPR through its CPR 10 mantra for revival after a sudden cardiac arrest. They currently hold three Limca Book of World Records for the maximum number of people trained in hands only CPR in one go. Keeping article 21 of the Indian constitution in mind, which guarantees a person Right to Life, Heart Care Foundation of India has also recently initiated a project called the Sameer Malik Heart Care Foundation Fund to ensure that no one dies of a heart disease just because they cannot afford treatment.

Heart Care Foundation of India and Indian Medical Association now part of NCD Alliance

Heart Care Foundation of India and Indian Medical Association now part of NCD Alliance

New Delhi India: Heart care Foundation of India and Indian Medical Association have joined the NCD Allincae, said Padma Shri Awardee Dr K K Aggarwal President Heart Care Foundation of India and incoming Honorary Secretary General IMA.

The NCD Alliance was founded by four international NGO federations representing the four main NCDs – cardiovascular disease, diabetes, cancer, and chronic respiratory disease.  

These involved International Diabetes Federation, World Heart Federation, and the Union for International Cancer Control.

Together with other major international NGO partners, the NCD Alliance unites a network of over 2,000 civil society organizations in more than 170 countries.  The mission of the NCD Alliance is to combat the NCD epidemic by putting health at the centre of all policies.

The NCD Alliance uses targeted advocacy and outreach to ensure that NCDs are recognized as a major cause of poverty, a barrier to economic development, and a global emergency. 

Other member associations from India are Disease Management Association of India; India800 Foundation, Breastfeeding Promotion Network of India, Indian Centre for Alcohol Studies, Indian Alcohol Policy Alliance and Indian Medical Association.

NCD Global Facts

• Non-communicable diseases (NCDs) are the world’s number one killer, bringing hardship to rich and poor nations alike.

• NCDs make the largest contribution to mortality both globally and in the majority of low- and middle- income countries (LMICs). 

• Worldwide, NCDs account for 60% (35 million) of global deaths.

• The largest burden - 80% (28 million) - occurs in LMICs, making NCDs a major cause of poverty and an urgent development issue. They will be the leading global cause of disability by 2030.

• NCDs in LMICs also put G20 nations at risk since we all benefit from healthy individuals and stable populations around the globe. 8 million people below the age of 60 die each year in LMICs from preventable causes, which include tobacco use, unhealthy diets, alcohol consumption, and physical inactivity. Lack of access to affordable medicines and health care services are also major causes of these preventable deaths.

• Globally, the NCD burden will increase by 17% in the next ten years, and in the African region by 27%. The highest absolute number of deaths will be in the Western Pacific and South-East Asia regions.

• This rapidly changing health and disease profile has serious implications for poverty reduction and economic development. NCDs strangle macro-economic development and keep the bottom billion locked up in chronic poverty. NCDs have a severe impact on individuals, communities and countries. The magnitude and rapid spread of NCDs means we are all headed for a sick future unless we take action now. Low-income countries still grappling with heavy burdens of infectious disease risk being overwhelmed by this wave of largely preventable NCDs.

Honorary Professor in Bioethics Awarded to Dr K K Aggarwal

Honorary Professor in Bioethics Awarded to Dr K K Aggarwal

Retired Justice of Supreme Court of Indian and Former Chairman Law Commission of India A R Lakshmanan delivered key note address on Bioethics during a National Conclave on the subject organized by Asia Pacific Network of UNESCO Bioethics organised at SRM University Potheri, Chennai.

Vice Chancellor of SRM University Doctor Dr T P Ganesan, Awarded "Honorary Professor in Bioethics" to incoming Indian Medical Association National President Dr A Marthanda Pillai and its incoming Honorary Secretary General Dr K K Aggarwal. Both of them are Recipients of Padma Shiri Awards.  They said IMA will educate all hits 2,50,000 members on Bioethics though IMA e-Connect program.

Dr N Dinesh Professor Psychiatry Amrita Institute of Medical Sciences Cochin also received the Honorary Professorship.

Tamilnadu State President of IMA Dr M Balasubramainan said that it is a great Honor for IMA Top Office Bearers to receive honorary professorships.

Dr Ruseell F D’ Souza Chairman of Asia Pacific network of UNESCO Bioethics said that UNESCO will join hands with IMA in the coming year to propagate the message of bioethics amongst the medical professionals with a standard curriculum.

Dr P Thangaraju SRM Pro Vice Chancellor, Dr Balakrishnan, Dean Medical Research, SRM University and Prof. Dr James Pandian, SRM Dean were present on the occasion and also deliberated on the subject.

Delegates from Tamilnadu, Kerala, Karnataka, Maharashtra, Delhi, Manipur & Nepal participated in the conclave.

Ebola can persist in the semen

Ebola in the semen

1. Ebola can be present in saliva, stool, semen, breast milk, tears, nasal blood, and a skin swab.

2. A study published in the Journal of Infectious Diseases (J Infect Dis. 1999 Feb;179 Suppl 1:S28-35) evaluated if convalescent body fluids contain Ebola virus and if secondary transmission occurs during convalescence. Twenty-nine Ebola hemorrhagic fever  convalescents and  their 152 house hold contacts were monitored for up to 21 months. Blood specimens were obtained and symptom information was collected from convalescents and their house hold contacts.  other body fluid specimens were also obtained from convalescents.  Joint and muscle pains were reported significantly more often by convalescents than house hold contacts. Evidence of Ebola virus was detected by reverse transcription-polymerase chain reaction in semen specimens up to 91 days after disease onset; however, these and all other non-blood body fluids tested negative by virus isolation.

 Among 81 initially antibody negative house hold contacts none became antibody positive.

Blood specimens of 5 house hold contacts not identified as Ebola hemorrhagic fever  patients were initially antibody positive. No direct evidence of convalescent-to- house hold contract transmission of Ebola fever was found, although the semen of convalescents may be infectious.

The existence of initially antibody-positive house hold contacts suggests that mild cases of Ebola virus infection occurred.

3. Who is a high risk Ebola Patient: Percutaneous (needle stick) or mucous membrane exposure to blood or body fluids (feces, saliva, sweat, urine, vomit, and semen) of a person with symptomatic Ebola virus disease and Exposure to the blood or body fluids (feces, saliva, sweat, urine, vomit, and semen) of a person with symptomatic Ebola virus disease without appropriate personal protective equipment (PPE). In both situations a person has to be symptomatic.

4. There is no identifiable risk when the contact is with an asymptomatic person who had contact with a person with Ebola and also contact with a person who is later diagnosed with Ebola virus disease, before the person developed symptoms.

5. Viral persistence — Virus can persist for some time in certain bodily fluids, such as semen and breast milk.

a     Follow-up studies of 40 survivors in the 1995 Kikwit, Democratic Republic of Congo outbreak showed that viral RNA sequences could be detected by RT-PCR in the semen of male patients for up to three months, and infectious virus was recovered from one individual 82 days after disease onset. [J Infect Dis. 1999;179 Suppl 1:S28.]

b  

         In only one known instance, during the 1967 Marburg outbreak, has viral persistence in semen led to virus transmission through sexual contact. [Curr Top Microbiol Immunol. 1999;235:49, Trans R Soc Trop Med Hyg. 1969;63(3):295.]

c     

      A study of patient samples collected during the outbreak of Ebola Sudan virus disease in Gulu, Uganda in 2000 detected virus in the breast milk of a patient, even after virus was no longer detectable in the bloodstream. Two children who were breast-fed by Ebola-infected mothers died of the disease. [J Infect Dis. 2007 Nov;196 Suppl 2:S142-7.]

d

         During the 2014 outbreak in West Africa, virus was cultured from a patient’s urine 12 days after the last positive culture was identified in plasma. [N Engl J Med. 2014 Oct]

6. Convalescent period of Ebola and Marburg virus disease is prolonged, and marked by weakness, fatigue, and failure to regain weight that was lost during illness. Extensive sloughing of skin and hair loss are commonly observed, possibly as a result of virus-induced necrosis of infected sweat glands and other dermal structures

7. There is no evidence that asymptomatic persons still in the incubation period are infectious to others.  But all symptomatic individuals should be assumed to have virus in the blood, and other body fluids, and appropriate safety precautions should be taken. [Arch Virol Suppl. 1996;11:141.]

8. Convalescence from Ebola Virus Disease is long and often associated with sequelae such as myelitis, recurrent hepatitis,  psychosis, or uveitis. Data on the post-recovery viraemic period are limited. As said above shedding of Ebola virus has been  reported in breast milk and semen after the virus has been cleared from blood. Viable virus has been isolated  from semen up to many weeks or months after recovery, and spermatogenic transmission of Marburg virus has been  documented. There is a paucity of data on Ebola virus in human egg cells. The risk of Ebola transmission should be considered in connection with reproductive cell donations, both for ‘partner’ and ‘other than partner’ donations.

However, the evidence that Ebola virus may persist for some time in the human body after recovery from Ebola Fever is  insufficient to define a specific deferral period for donors who have recovered from Ebola Fever. The current guidance  stipulates deferral for 12 months following recovery from a viral hemorrhagic fever and this recommendation  also applies to donors who have recovered from Ebola Fever. In addition, living or deceased donors of substances of human origin should be negative for Ebola virus by NAT testing

9. A deferral of donation for two incubation periods will provide a reasonable margin of safety for asymptomatic donors returning from Ebola affected areas. The longest incubation period for Ebola Disease has been 25 days. Thus, asymptomatic travelers or residents returning from Ebola Virus affected areas should be temporarily  deferred from donation of substance of human origin including blood for two months after leaving an area affected by Ebola virus.

10. Men who have recovered from the illness can still spread the virus to their partner through their semen for many months after recovery. For this reason, it is important for men to avoid sexual intercourse after recovery or to wear condoms if having sexual intercourse during this period after recovery.

[ Dr K K Aggarwal is Padma Shri, Dr  B C Roy National and National Science Communication Awardee, President Heart Care Foundation of India and Senior National Vice President, Indian Medical Association]

Zinc Phosphode the lethal killer in Chhattisgarh sterilization tragedy

New Delhi: After 13 women died in a sterilization programme in Chhattisgarh, a preliminary enquiry has revealed that the drug used during the procedure could have been contaminated with zinc phosphide, widely used as rodenticide and perhaps could be the cause of death of the victims.

Confirming these findings, Commission Bilaspur Division, Sonmani Borah, said traces of zinc phosphide have been found in Ciprocin 500mg tablets, manufactured by Mahawar Pharmaceutical Pvt Ltd. These tablets were distributed to all the women who underwent sterilizations at the three health camps - Takhatpur, Pendra and Marwahi - in Bilaspur district on last Saturday and Monday.

Mahawar Pharma Pvt Ltd's director Ramesh Mahawar and his son Sumit have been arrested under section 420 for cheating, based on a complaint lodged by Food and Drug Administration authorities.

All about Zinc Phosphide

Zinc phosphide can be prepared by the reaction of zinc with phosphorus; however, for critical applications, additional processing to remove arsenic compounds may be needed.

Zinc phosphide reacts with water to produce phosphine and zinc hydroxide. Metal phosphides is used as rodenticides.

A mixture of food and zinc phosphide is left where the rodents can eat it. The acid in the digestive system of the rodent reacts with the phosphide to generate the toxic phosphine gas.

Other pesticides similar to zinc phosphide are aluminium phosphide and calcium phosphide.

There is usually only a short interval between ingestion of phosphides and the appearance of systemic toxicity. Phosphine-induced impairment of myocardial contractility and fluid loss leads to circulatory failure, and critically, pulmonary edema supervenes, though whether this is a cardiogenic or non-cardiogenic is not always clear.
Metabolic acidosis, or mixed metabolic acidosis and respiratory alkalosis, and acute renal failure are frequent.

Other features include disseminated intravascular coagulation, hepatic necrosis and renal failure. There is conflicting evidence on the occurrence of magnesium disturbances.

There is no antidote to phosphine or metal phosphide poisoning and many patients die despite intensive care. Supportive measures are all that can be offered and should be implemented as required.

Depression linked to over 50% of heart blockages

Dr. Rick Levy from  Washington, DC who will be delivering a lecture on improving patient outcomes by treating stress, depression and  anxiety in the forthcoming Cardiological Society of India meet to be held at Hyderabad in early December said that depression, anxiety and ‘chronic worry’ correlate with a 2 to 5 times higher risk of developing heart blockages and 3 to 5 times higher morbidity and mortality  patients with established blockages.

Screening and treating heart patients for depression and anxiety  should be a standard practice. In the west over half of all heart patients suffer from depression or anxiety at some point, said Dr H K Chopra incoming President of National CSI.

A busy cardiologist can identify patients with clinical levels of depression and anxiety using an easy two-question Patient Health Questionnaire, or PHQ-2 – self-administered by the patient in less than a minute, and scored by a nurse or admitting staff member in less than 15 seconds.

The two questions to be asked are over the past two weeks how often have you been bothered by any of the following problems: Little interest or pleasure in doing things and Feeling down, depressed, or hopeless.

Give zero marks for not at all; 1 mark for several days, 2 marks for 50% of the days and 3 marks for every day. If the patient has a positive response to either question he or she needs a referral and treatment.  Maximum marks can be 6 and a cut off of 3 points can be taken a point for referral and treatment.

Commenting on the study Padma Shri, Dr B C Roy National and National Science Communication Awardee Dr K K Aggarwal Senior National Vice President Indian Medical Association said that Psychotherapy and regular meditation have been clinically proven to improve health outcomes for heart patients with depression and anxiety.

SSRIs are the only antidepressant proven relatively safe for heart patients.

Long-term use of mobile and cordless phones is associated with an increased risk for brain cancer

It's official: Long-term use of mobile and cordless phones is associated with an increased risk for glioma, the most common type of brain tumor as per the latest research published online on October 28 in Pathophysiology.

The new Sweden study by Dr Lennart Hardell, Professor of Oncology at University Hospital, shows that the risk for brain tumor is tripled among those using a wireless phone for more than 25 years and that the risk is also greater for those who had started using mobile or cordless phones before age 20 years.
The widespread use of wireless communications has resulted in greater exposure to radiofrequency electromagnetic fields and the brain is the main target of these radiations when these phones are used, with the highest exposure being on the same side of the brain where the phone is placed.
In the study an increased risk for brain tumor was associated with use for more than 1 year of both mobile and cordless phones and the highest risk was for those with the longest latency for mobile phone use over 25 years.

The precautions, include using hands-free phones with the "loud speaker" feature and text messaging instead of phoning.


Talking on mobile is risky when driving but talking to friend in the car is less risky when he can also see the road

Mobile conversations are an enemy to safe driving. A new Canadian study from University of Alberta in Edmonton finds that drivers do best when they don't talk and simply focus on the road, if they must talk, it's better if the person they are talking to has his or her eyes on the road, too. That could mean either sitting in the passenger seat or via a specially designed videophone.

The study, published recently in Psychological Science, tested driver safety in one of four conditions, using a driving simulator.

1. A silent driver alone in the vehicle.

2. The driver accompanied by a passenger, where they engaged in conversation.

3. The driver speaking to someone on a hands-free cellphone with a standard audio-only connection.

4. The driver speaking to someone remotely with a one-way video connection. That connection allowed the person on the other end of the line to see both the driver and the driver's perspective of the road ahead, much as if they were a passenger in the car.

The study found

1. Nothing was as safe as driving alone in peace and silence.

2. Talking to a fellow passenger in the car was less safe than driving alone, but it was still safer than being on a typical, audio-only cellphone call, which tripled the odds for a collision compared to silent driving.

3. The videophone call was safer than having an audio call, and almost as safe as having a talking passenger sitting beside you.