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  • 'Don't know what caused the deaths'

    'Don't know what caused the deaths'
    By: Alifiya Khan Date: 2009-11-05 Place: Pune


    Doctors at Sassoon hospital anxiously await report on 35 patients who died of infection that caused symptoms similar to swine flu

    Doctors at Sassoon Hospital, who are in the thick of the swine flu battle, are a worried lot. Thirty-five patients with swine flu-like symptoms died in the last 45 days at the hospital, and not one of them tested positive for swine flu. The doctors still don't know what caused the death of these patients.

    Tell the world
    "We requested the National Institute of Virology (NIV) to check tissue samples from these patients for eight to 10combinations of the HN virus subtype like H1N2 or H2N2. It is extremely important that the virus is identified so we can decide on the course of treatment," said Dr Arun Jamkar, dean of Sassoon Hospital, which has been dubbed as the epicentre of the swine flu activity in the state.

    On October 28, doctors at Sassoon shared the data on these deaths with the Center for Disease Control, Atlanta, USA, and virologists across the world in a videoconference.

    Despite repeated attempts, Dr A C Mishra, director of NIV, remained unavailable for comment. Dr Mandeep Chaddha, deputy director, NIV, said she wasn't authorised to speak to the media.

    Impact on vaccine
    Dr Pravin Shengare, joint dire-ctor, Directorate of Medical Education and Research, who attended the video-conference, said, "The NIV's report won't have an effect on vaccine production, but it is important to know if another dominant virus sub-type is circulating. If this is the case, a detailed analysis of deaths that occurred due to unexplained symptoms will have to be undertaken," he said.

    "If it is found that there is a different strain of the virus, then that strain should ideally be incorporated in the H1N1 vaccine that is being developed by NIV. It is also important to understand how potent that virus is," said
    JP Muliyil, senior scientist and epidemiologist at Christian Medical College, Vellore.

    Shengare, however, pointed out that the WHO had recommended that a monovalent vaccine against H1N1 be developed. Modifying a vaccine so it provides protection from other viruses would take too much time and effort, he felt. "Even if a new virus sub-type is circulating, the H1N1 vaccine that is being developed won't be useless, as it can still be used to fight swine flu. If there is another virus, we'll have to deal with it separately," said Shengare.

    "If you could for a moment rise up out of your own beloved skin and appraise ant, human, and virus as equally resourceful beings, you might admire the accord they have all struck in Africa. Back in your skin of course, you'll shriek for a cure. But remember: air travel, roads, cities, prostitution, the congregation of people for efficient commerce - these are gifts of godspeed to the virus"
    The Poisonwood Bible

  • #2
    Re: 'Don't know what caused the deaths'

    #1: "Thirty-five patients wngoing of events.ith swine flu-like symptoms died in the last 45 days at the hospital, and not one of them tested positive for swine flu. The doctors still don't know what caused the death of these patients."
    "Tell the world
    "We requested the National Institute of Virology (NIV) to check tissue samples from these patients for eight to 10combinations of the HN virus subtype like H1N2 or H2N2. It is extremely important that the virus is identified so we can decide on the course of treatment," said Dr Arun Jamkar, dean of Sassoon Hospital, which has been dubbed as the epicentre of the swine flu activity in the state."



    Ukraine is not the exception, than.
    Bad signs.

    Comment


    • #3
      Re: 'Don't know what caused the deaths'

      That first article is a bit mis-worded I suspect. Here is a report of a patient dying at that hospital and testing positive for Pandemic H1N1.

      I suspect they mean to say that in addition to however many confirmed H1N1 deaths, there are 35 that tested negative.



      Pune, Nov 3 (PTI) The swine flu toll in the city rose to 97 with the death of a 29-year-old youth, health officials said today.

      The victim, who succumbed to the virus on Sunday, was a resident of Wagholi, 20 km from here, and had been taken to various hospitals before being admitted to government-run Sassoon hospital on October 30 after testing positive for H1N1 virus, they said.

      The state health machinery has stepped up an awareness drive stressing importance of early detection of swine flu symptoms with growing concern over a speculated "second wave" of the pandemic with the onset of the winter.

      Meanwhile, citrus fruit prices have risen by about 20 per cent here due to their growing demand for their resistance enhancing properties. .

      Comment


      • #4
        Re: 'Don't know what caused the deaths'

        Here is another confirmed H1N1 fatality at that hospital.

        Thirty-year-old Manju Ashok Kalya, a resident of Dalvinagar in Chinchwad, succumbed to the H1N1 influenza on Sunday, taking the death toll in the city


        One more succumbs to H1N1 in city; toll 91
        TNN 26 October 2009, 05:16am IST
        Print Email Discuss Bookmark/Share Save Comment Text Size: |

        PUNE: Thirty-year-old Manju Ashok Kalya, a resident of Dalvinagar in Chinchwad, succumbed to the H1N1 influenza on Sunday, taking the death toll in
        the city to 91. ( Watch Video )

        Before being admitted to the Sassoon Hospital on October 20, Manju was taken to private hospitals in Pimpri and then to the government-run YCM hospital on October 19. "The health authorities of the YCM hospital referred her to the Naidu hospital which in turn asked her to go to the Sassoon. She was admitted to the Sassoon hospital at 3 am on October 20," said Ashok Mehta, joint director of the state health services.

        Comment


        • #5
          Re: 'Don't know what caused the deaths'

          And this article from over a week ago indicates that 47 confirmed fatalities at that hospital have occurred (and already mentions 36 that tested negative).

          I suspect even the negative ones are probably H1N1 fatalites. The tests are not 100% accurate, especially when taken late in the illness. And from the wording, I suspect many of the tests were taken after the patients died, which obviously would be late in the illness.

          An alternative possiblility is that those 36 deaths represent background noise. While they weren't caused by influenza, there is no mention of testing for parainfluenza, RSV, HMPV, etc. That is apparently the hospital that treats ARI patients in Pune, a very large city. It could easily be that 36 ARI deaths would have occurred in Pune even without a Pandemic.

          Doctors at the state government-run Sassoon General Hospital in Pune want the National Institute of Virology (NIV) to “decode the mystery".


          Two out of three victims test negative
          Nozia Sayyed / DNAWednesday, October 28, 2009 2:40 IST Email

          Print

          Share

          Mumbai: Doctors at the state government-run Sassoon General Hospital in Pune want the National Institute of Virology (NIV) to "decode the mystery" of the deaths of 36 patients whose samples tested negative for the Influenza A infection.


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          The swine flu pandemicAll 36 people were admitted to the hospital since August on the suspicion of being H1N1 cases. "We have not been able to find any definite clue about the death of so many people whose samplestested negative," said Sassoon Hospital dean Dr Arun Jamkar.

          Of the 93 confirmed deaths due to swine flu in the city, 47 were at the government-run hospital while the rest were at other healthcare establishments designated to treat such cases.

          Jamkar said the hospital has so far recorded 83 deaths, of which 47 were swine flu deaths. "The samples of the remaining 36, who were admitted with flu-like symptoms and were termed as suspected cases, have tested negative for H1N1. They also did not suffer from dengue or any other bacterial infection," he said. The large number of deaths due to "an unknown factor" has raised concern.

          "We have asked the NIV to study the samples for all types of influenza and see if there is a common link in these deaths," Jamkar said. The state health officials and the directorate of medical education and research have also been informed.

          Head of the chest and tuberculosis department at the Sassoon Hospital Dr S Ghorpade said, "We have to check for any histopathological changes or atypical pathogens, and have sought the NIV's help."

          Deputy director of NIV Dr Mandeep Chaddha said that samples needed testing again to find the exact cause of death. "There are many kinds of viruses and parainfluenza," she said, adding that all samples are currently being tested only for the H1N1 virus.

          Comment


          • #6
            Re: 'Don't know what caused the deaths'

            Sassoon has been in the thick of fighting the H1N1 virus, and doctors there should be able to recognize the symptoms. There have been 50 confirmed deaths there as of Nov 3rd. The phenomenon of symptomatic cases testing negative in Pune is not limited to just the last 45 days. I have included some of those in our database. http://ft100.dabbledb.com/publish/fl...dualah1n1cases

            IN16: Died Sassoon Aug 18, ARDS, tested negative.
            IN18: Died SM hospital, ex Sassoon Aug 12, tested negative.
            IN22: Fever and breathlessness for 4 days, died Aug 13, tested negative.
            IN23: Worker from Pune died in Bhilali, Aug 12 flu like symptoms, tested negative.
            IN30: Died Sassoon, Aug 16, fever, chestpain, breathlessness, tested negative.
            IN162: Died Sassoon Sep 8, ARDS within 1 hour of admission, tested negative.

            On many occasions, Sassoon is the last port of call for the patients, after being treated in one or several other hospitals. It's probable that at least in some cases the H1N1 is long gone and the patient is struggling against the secondary infections.
            Twitter: @RonanKelly13
            The views expressed are mine alone and do not represent the views of my employer or any other person or organization.

            Comment


            • #7
              Re: 'Don't know what caused the deaths'

              I doubt that there will be no traces of the virus in the deceased after a few month.

              Why than they go up in Alaska digging corps burried there in ice almost 100 years ago, and stil found enaugh of the 1918 virus to recreate it.

              So, for a few months after, this pandemic virus must be stil there, if it is the agent.

              But now with many world areas describing the same, and suspecting several diferent bugs, there could be other matters, as wroted in #5:

              "Head of the chest and tuberculosis department at the Sassoon Hospital Dr S Ghorpade said, "We have to check for any histopathological changes or atypical pathogens, and have sought the NIV's help.""

              Comment


              • #8
                Re: 'Don't know what caused the deaths'

                tropical, here's another case, from Mumbai, Maharashtra that is not counted as an H1N1 death;

                The BMC, however, maintained that one of the two persons-a woman from Mira Road-had reported negative for the virus the second time she was tested and so could not be included in the disease toll. However, the victim-Urvashi Singh-had tested positive for H1N1 the first time round.

                -snip-

                Singh became the zone's 14th swine flu victim when she died at Bombay Hospital on Saturday (September 6). She went to Bhagwati Hospital on 13 August and was sent to Kasturba Hospital, where she was put on Tamiflu even before the test reports came; she then tested positive for H1N1. On August 17, she delivered a still-born baby at Kasturba. She was later shifted to Bombay Hospital, but, before that, went through another round of H1N1 test. This test, however, gave a negative result. "So, hers is not a death due to swine flu,'' Thanekar said.

                Swine flu claimed two more lives in the city and its distant suburbs over Friday and Saturday, taking the total number of H1N1 casualties in the Mumba


                In several cases I've come across, there is no postmortem performed and the body is released to the family. So, while traces of the disease's effects, and perhaps traces of the disease itself may be present, they are not necessarily being discovered.
                Twitter: @RonanKelly13
                The views expressed are mine alone and do not represent the views of my employer or any other person or organization.

                Comment


                • #9
                  Re: 'Don't know what caused the deaths'

                  Originally posted by RoRo View Post
                  On many occasions, Sassoon is the last port of call for the patients, after being treated in one or several other hospitals. It's probable that at least in some cases the H1N1 is long gone and the patient is struggling against the secondary infections.
                  Exactly. Also, this phenomenon is not limited to Sassoon, nor to Pune, nor to India. All over the world, there are cases that symptomatically are H1N1, but test negative (remember the atypical pneumonia in Puebla thread and the two dead students at Miami of Ohio). These test results are obviously a peculiarity of the test (virus long gone, false negative, etc.) and not indicative of a second pandemic virus.

                  On a second note, I think the first article may be poor. If they thought there was a second virus, you would get an unsubtypable Influenza A test, just like the CDC did in March. You wouldn't need to start guessing HXNY combinations until you got the right one, as the article implied.

                  Comment


                  • #10
                    Re: 'Don't know what caused the deaths'

                    #9:
                    "These test results are obviously a peculiarity of the test (virus long gone, false negative, etc.) and not indicative of a second pandemic virus.

                    On a second note, I think the first article may be poor. If they thought there was a second virus, you would get an unsubtypable Influenza A test, just like the CDC did in March."


                    Yes, such events are note, and it could be a peculiarity of the tests also,
                    but not a peculiarity of an pathology report viewing all the body.

                    What is with common flu viruses, are they isolated always, or not?
                    If a pathology professional can't isolate any virus, from a person died of it, with a supposed mass of viruses circulated throughout the body,
                    than maybe this bug is designed indeed ...

                    About the non named sybtype flu virus result, it could be vaccant if the agent is not a flu virus, if only flu tests were used.
                    The viral tests gurus will know better ...

                    Comment


                    • #11
                      Re: 'Don't know what caused the deaths'

                      Originally posted by tropical View Post

                      About the non named sybtype flu virus result, it could be vaccant if the agent is not a flu virus, if only flu tests were used.
                      The viral tests gurus will know better ...
                      It is possible that these cases are caused by something other than flu (bacteria? RSV? HMPV?), but very unlikely. These cases didn't happen last year when there was no Pandemic, but are happening this year wherever the Pandemic hits. To me, the inevitable conclusion is that they are due to Pandemic H1N1.

                      Comment


                      • #12
                        Re: 'Don't know what caused the deaths'

                        Originally posted by alert View Post
                        It is possible that these cases are caused by something other than flu (bacteria? RSV? HMPV?), but very unlikely. These cases didn't happen last year when there was no Pandemic, but are happening this year wherever the Pandemic hits. To me, the inevitable conclusion is that they are due to Pandemic H1N1.
                        In the era of chimeras, everything could be always possible,

                        or maybe such activities ceased

                        sarcasm apart, the foging about precisely what kind of bug is acting,
                        citing generic naming symptoms as ARI, fueling the above speculations.

                        When SARS pop up, it was classified soon as possible the causative agent.

                        If there is only an already note pandemic flu agent to make the infections,
                        than it couldn't be named ARI, or similar, but pandemic flu.
                        If it is cold, it couldn't be so serious.

                        If there are several flu or other viruses, with the actual high tech bio-labs, they could identified the bugs fast (of course, if somebody send the samples).

                        So, why this mess?
                        If it is anywhere:
                        pandemic flu orig. virus, adenovirusX, ordinary cold, seasonal flu Y;
                        than their names must be used for public release,
                        not: "viral illnesses", "ILI", "ARI", "cold", etc.

                        Generic names for serious strange, and deadly illness behaviour,
                        could only fuel panic, and spread fear into the population.

                        Comment


                        • #13
                          Re: 'Don't know what caused the deaths'

                          Sorry for the confusion in those abbreviations. Those were actual names of agents: RSV is respiratory synctial virus, HMPV is human metapneumovirus, etc. The only abbreviation of the sort you mention is ARI for acute respiratory infection, which is a general term (dating back before the SARS outbreak) for a respiratory illness of undetermined etiology. Since most seasonal flu-like illness were never tested for flu (and still often aren't), ARI was a standard diagnosis, and not indicative of a novel agent.

                          And I think that isn't what happened here, anyway. I presume those are really H1N1 cases, but no test is 100% accurate, especially on a dead patient, where the casuative agent could be long gone.

                          Comment


                          • #14
                            Re: 'Don't know what caused the deaths'

                            I recall reading about a weekago that Indian doctors reported that the clinical picture of H1N1 patients (or suspected patients) had changed. Unfortunately I do not have the link, but could that be linked to these deaths that tested negative ?

                            Comment


                            • #15
                              Re: 'Don't know what caused the deaths'

                              My abreviations was related to the worldwide generic naming of illnesses on the field, without naming precisely its agents, stil at least 3 weeks after their appearance, when they must already know it precisely.

                              Such practice concealed the true agents publication from the field, and makes it possible and necessary such unfruitfull guessing what are the real bugs on the fields worldwide.

                              The second point was that if for whatever reason the specialists weren't able to isolate and name the microorganism previously,
                              the cited pathologysts obductions of deceased persons,
                              genericaly labeled having ARI/viral illness/ILI/... and died,
                              will found traces of a flu virus - IF the microorganism was a flu virus,
                              no matter any previous tests results.

                              So if they not found flu viruses at obduction, flu isn't the causative agent.


                              Originally posted by alert View Post
                              Sorry for the confusion in those abbreviations. Those were actual names of agents: RSV is respiratory synctial virus, HMPV is human metapneumovirus, etc. The only abbreviation of the sort you mention is ARI for acute respiratory infection, which is a general term (dating back before the SARS outbreak) for a respiratory illness of undetermined etiology. Since most seasonal flu-like illness were never tested for flu (and still often aren't), ARI was a standard diagnosis, and not indicative of a novel agent.

                              And I think that isn't what happened here, anyway. I presume those are really H1N1 cases, but no test is 100% accurate, especially on a dead patient, where the casuative agent could be long gone.

                              Comment

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