COMMENT
Averting deaths in Muzaffarpur
T. Jacob John JUNE 19, 2019 00:15 IST
UPDATED: JUNE 19, 2019 00:35 IST
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All it would have taken was to ensure that the children had a meal at night
Along with my colleagues, I had investigated the so-called mystery disease in Muzaffarpur, Bihar, during its outbreak in 2012, 2013 and 2014. The local name for it was acute encephalitis syndrome, but we found that the disease was not encephalitis but encephalopathy. This distinction is important. Encephalitis results from a viral infection, unless proved otherwise. The pathology is primarily in the brain. Encephalopathy is a biochemical disease, unless proved otherwise. The primary pathology is not in the brain. Specific treatment is scanty for viral encephalitis, but encephalopathy is eminently treatable.
Hypoglycaemia (when the level of glucose in the blood falls below normal) is usually due to an overdose of insulin in children with diabetes. It is easily corrected with oral sugar or intravenous glucose. The easily available 5% glucose solution suffices. Hypoglycaemic encephalopathy, however, is different from simple hypoglycaemia.
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This disease was reminiscent of the Jamaican Vomiting Disease, a form of hypoglycaemic encephalopathy. It is triggered when unripe ackee fruits are eaten. These fruits contain a substance, methylene cyclopropyl alanine, which blocks a biochemical process called fatty acid oxidation, or gluconeogenesis.
There are two essential steps: gluconeogenesis is turned on and is then blocked midway by methylene cyclopropyl alanine. The back-up molecules of the unfinished process are certain amino acids that are highly toxic to the brain cells. Ackee and litchi belong to one plant family. My toxicology colleague, Dr. Mukul Das, found generous quantities of methylene cyclopropyl glycine in litchi fruit pulp.
The disease affected only malnourished children between the ages of two and 10. A majority of them were from families camping in orchards for fruit harvesting. No child from the nearby towns fell ill. Children of well-to-do families never fell ill.
Litchi harvest usually begins by 4 a.m., which means that families are awake before that. They go to sleep early. If children go to sleep without dinner, parents usually do not wake them up and feed them. Litchis are collected in bunches and sent to the collection points, but single fruits fall to the ground. Children are free to collect and share the fruits with their friends.
With this information we made the hypothesis that the disease was hypoglycaemic encephalopathy. Along with my paediatric colleague, Dr. Arun Shah, we conclusively showed that the disease was indeed hypoglycaemic encephalopathy. With all the pieces in hand, we reconstructed the disease pathway.
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We were unable to demonstrate aminoacidaemia in children with hypoglycaemic encephalopathy, but that was done by investigators from the U.S. Centers for Disease Control and Prevention (CDC). The only missing piece in our studies was filled in by CDC colleagues.
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In 2015, all primary health centres were supplied with glucometers to check the blood glucose levels of sick children. Doctors were instructed to take a blood sample for glucose estimation and, irrespective of the results, infuse 10% glucose intravenously. To correct mild hypoglycaemia, 5% glucose is enough, but here the problem is not hypoglycaemia alone, but aminoacidaemia as a result of blocked gluconeogenesis. To prevent any further back-up amino acid from accumulating, the fatty acid oxidation process has to be turned off quickly. That requires raising blood glucose level to abnormally high levels so that insulin secretion is stimulated, and that in turn turns off the gluconeogenesis.
What Dr. Shah and I found was that if
ill children are infused with 10% glucose within four hours of onset of brain dysfunction, recovery is fast and complete. If only 5% glucose is given, or if 10% glucose is not administered within four hours, recovery is unlikely. I do not have detailed information from the field, but there seem to have been some human slip-ups this time.
Glucometers have not been maintained well. Health education was not sustained. New doctors are not familiar with all the information. Instead of 10% glucose, 5% is given. Children are taken mostly to private clinics and are then referred to the Sri Krishna Medical College in Muzaffarpur city since ambulance services are free of cost and easily available. Ambulances take more than four hours to reach the city hospitals from many rural clinics. We might think each error is minor, but when all the errors add up they contribute to deaths that should have been averted.
https://www.thehindu.com/opinion/op-ed/averting-deaths-in-muzaffarpur/article28067239.ece
Bihar Encephalitis: More doctors deputed in Muzaffarpur
ANI
19 Jun 2019, 20:03 GMT+10
Muzaffarpur (Bihar) [India], June 19 (ANI): In the wake of the growing number of deaths due to Acute Encephalitis Syndrome (AES) in Bihar's Muzaffarpur district, the State Health Society has deputed more doctors from neighbouring districts.
The death toll due to encephalitis rose to 112 on Wednesday, officials said. As many as 93 children have died at Sri Krishna Medical College and Hospital (SKMCH) while 19 others lost their lives at Kejriwal Hospital.
The State Health Society had on Tuesday ordered to delegate more doctors in Muzaffarpur from Darbhanga, Supaul, Madhubani, Samastipur and Sitamarhi districts.
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https://www.sierraleonetimes.com/ne...ephalitis-more-doctors-deputed-in-muzaffarpur
In wake of deaths due to encephalitis, C'garh govt to give free food to Bastar tribals
PTI Published : Jun 19, 2019, 3:14 pm IST Updated : Jun 19, 2019, 3:14 pm IST
The announcement comes in the wake of over 100 children deaths in Bihar's Muzaffarpur district due to acute encephalitis syndrome.
Raipur: Chhattisgarh Chief Minister Bhupesh Baghel announced on Wednesday that tribals living in the forest regions of Bastar would soon get free nutritious food through gram panchayats and access to medical facilities.
The announcement comes in the wake of over 100 children deaths in Bihar's Muzaffarpur district due to acute encephalitis syndrome (AES).
Baghel said the state government would be launching two new schemes for tribals, related to malnutrition and healthcare facilities. These schemes will play a pivotal role in improving the health status of tribals.
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https://www.asianage.com/india/poli...govt-to-give-free-food-to-bastar-tribals.html
After encephalitis deaths, Odisha orders testing of litchi fruit
ANI18 June 2019
Bhubaneswar (Odisha) [India], June 19 (ANI): Amid the outbreak of Acute Encephalitis Syndrome (AES) in Bihar which claimed 109 lives, Odisha Health Minister Naba Kishore Das has directed officials to ascertain toxic content in litchi fruit being sold in the state.
The directive has come in the wake of reports that encephalitis is spreading in litchi growing areas of Bihar, including Muzaffarpur district and other parts of the country and that consumption of the fruit was among the factors for the spread of the disease.
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https://in.news.yahoo.com/encephalitis-deaths-odisha-orders-testing-litchi-fruit-031146777.html
No hindrance of AES: Two more children died in Muzaffarpur, 11 new patients recruited
Publish Date: Wed, 19 Jun 2019 11:55 AM (IST)
So far 142 children have died from AES in Bihar. While there are 454 recruits. On the other hand, 122 children have died due to the involvement of SKMCH and Kejriwal in Muzaffarpur.
Muzaffarpur, JNN The AES broke the record of 2012 in Muzaffarpur. So far 122 children have died due to this disease. However, 454 children have been admitted in various hospitals. In 2012, 120 children were killed and 336 patients were admitted. Two more children died in SKMCH on Wednesday morning. Six new patients have been admitted here in critical condition. Five children have been brought to Kejriwal Hospital. Earlier on Tuesday, four patients had died, while 39 victims were admitted.
Disease taken in 2012
In the year 2012, the disease took a terrible appearance. More than three hundred children are sick 120 of them died Together, so much death left the government restless. In the next two years, there has been a series of deaths. But, the number is still intimidating.
Death figure
Year-to-death
2010-59-24
2011-121-45
2012-336-120
2013-124-39
2014 -342 -86
2015 -75 -11
2016-30-30
2017-09 -04
2018 -35 -11
2019-454-122 *
* Updates until 11:30
Posted by: Ajit Kumar
https://www.jagran.com/bihar/muzaff...-and-11-admitted-in-muzaffarpur-19325682.html
Lechi is not infamous, no connection to AES Muzaffarpur News
Publish Date: Wed, 19 Jun 2019 01:34 PM (IST)
Lechi is not infamous, no connection to AES Muzaffarpur News
Lychee farmers have refused to accept Leichi's relationship with AES. The doctors treating the children said that the litchi has nothing to do with this disease.
Muzaffarpur, JNN The identity of Lichi Muzaffarpur is. Its history is almost two hundred years old here. The AES is coming out from the last 16-17 years. In this case, the AES has a litchi connection, it is not getting anybody's hug.
Dr. JP Mandal, associate professor of pediatrician and SKMCH says that there is no relation to the disease from the litchi. This disease occurs two to three months before the fruit comes in litchi and two months after harvest. So it is appropriate to blame the litchi. There is a possibility of its viral disease. It may be that in Lychee or its surrounding gardens its virus flourishes at a particular time.
It has not been identified yet. In other districts also there are litchi orchards and the temperature remains the same. In such a situation, it can not be said with a claim. This disease is AES only. It does not occur with hypoglyceria. Dr Chetanya Kumar, a famous pediatrician of Kejriwal, says that anyone in the case history of Akrut Children did not talk about eating lechi. It is to say that this disease is caused by litchi, it is completely wrong.
Conspiracy of the Mango lobby
Bholaanath Jha, the head litchi producer of garden gems and district, alleges that the conspiracy of all Mango (mango) lobby is. In other states, the market is sold at a price of 10-15 kg. At the same time, lychee ranges from 200 to 250 rupees. Its juices are sold all over the world. There was no complaint from anywhere. Misleading propaganda is being done under a conspiracy to discourage the cultivation of litchi and business. People in urban areas eat more than rustic area, but all of them are from the rustic area. They say that the litchi is produced in many other countries, including China, Thailand and America. If this is an AES, then this disease can be found there too. Litchi of Muzaffarpur is sold in different parts of the country.
The children who eat there also get sick. There is no evidence of the disease in the investigation of the Lychee Research Center. Women laborers are more in line with barricades and packaging. Together they have children too. These children live in the litchi garden throughout the day and eat fruits. Sometimes a child is not sick Director General of the Department of Agriculture also dismissed his report on not receiving evidence from American scientists. When the talk of litchi is being done, then join the director of the research center of Litchi, which is now forming the government for the investigation. Satish Dwivedi, chief cultivator of District Kisan Bhushan and Litchi, says that the Lechi can be AES, it is beyond comprehension. Everyone lickers of his garden, but no one is sick till date.
Litchi found in the investigation of the Lychee Research Center
Dr Vishal Nath, director of the National Leitchi Research Center, says that the lechi was completely correct in the investigation. There is no element of disease in it. Lechi is quite good and healthy. It should not be discredited.
The first child was born in January
The record of SKMCH is also denying the relation of the disease with litchi. This year, Gaddu Kumar (12) of Dargah village in Katra's first Akrath Katra was brought to SKMCH on January 25. After this, Meharaj (16) of Sitamarhi on March 5, Abdal Halal (4) of Shivar on April 17, Birju Kumar of Auraii on April 22 and 3.6 on April 27, Nikki Kumari (2.6) of Sitamarhi was brought here. However, the fruit of the lychee gets cooked after May 20th. In January it does not even matter.
Posted by: Ajit Kumar
https://www.jagran.com/bihar/muzaffarpur-leichi-does-not-have-any-connection-with-aes-19325799.html
