Medicine Departement Igesih Jhilmil

04/01/2025

*Human Metapneumovirus (HMPV) infections in China*.
According to recent news, this surge is *particularly affecting children under the age of 14*, with the northern provinces experiencing a more pronounced upward trend in cases.
China's National Disease Control and Prevention Administration has responded by piloting a monitoring system for respiratory diseases, including pneumonia of unknown origin, to better manage and track these infections.

This increase in HMPV cases comes *at a time when other respiratory illnesses are also on the rise*, contributing to crowded hospitals during the winter season.

*Educate parents or caregivers on signs of respiratory distress that warrant immediate medical attention*.

Given the rise in HMPV cases, clinicians should maintain a *high index of suspicion* for this virus, especially in regions reporting increased activity.

*Clinical tips* for managing Human Metapneumovirus (HMPV) infections, especially given the context of an increase in such cases:

*Clinical Presentation:*

🌹Symptoms: HMPV can present with symptoms similar to other respiratory viruses, including *cough, fever, nasal congestion, and shortness of breath*. In

*severe cases, it can lead to bronchiolitis or pneumonia*, particularly in infants, young children, the elderly, or those with weakened immune systems.

*Diagnosis:*
Testing: Since HMPV symptoms overlap with other respiratory viruses, *PCR testing is the most reliable* method for definitive diagnosis. However, in many settings, treatment might be based on clinical presentation due to limited access to specific HMPV tests.

*Differential Diagnosis*: Distinguish from influenza, *RSV, and other common respiratory pathogens*, especially in peak seasons for multiple viruses.

*Management:*
*Supportive Care:*
🌹Hydration: Ensure adequate hydration, especially in children who might refuse fluids due to respiratory distress.

*Fever and Pain Relief:* Use acetaminophen or ibuprofen for fever and pain relief, but be cautious with dosing, especially in pediatric patients.

🌹Oxygen Therapy: For those with significant respiratory distress, consider oxygen supplementation.

🌹Antiviral Therapy: There's no specific antiviral treatment for HMPV.

*Management is largely supportive*, focusing on symptom relief and monitoring for complications.
Isolation: In healthcare settings, isolation precautions should be taken to prevent nosocomial spread, especially since HMPV can lead to outbreaks in hospitals.

*Prevention*:
🌹Hand Hygiene: Emphasize rigorous hand hygiene practices among patients, caregivers, and healthcare workers

🌹Respiratory Etiquette: Teach covering coughs and sneezes, and avoiding close contact when ill.

🌹Isolation of Sick Individuals: Advise sick individuals to stay home to prevent spreading the virus.

*Special Considerations*:
High-Risk Groups: Pay extra attention to *infants, elderly, immunocompromised patients,* and those with chronic lung conditions. These groups are at higher risk for severe disease and may require hospitalization.

*Outpatient vs. Inpatient* Care: Decide based on the severity of symptoms, age, and underlying health conditions. Infants with significant respiratory distress or dehydration might need inpatient care.

*Vaccination*: Currently, there's *no vaccine* for HMPV. However, keeping up with vaccines for other respiratory infections (like influenza) can help in differential diagnosis and reduce the overall burden on respiratory health.

*Follow-Up:*
Monitor patients closely for worsening symptoms or secondary bacterial infections, which might require antibiotics if they occur.
Educate parents or caregivers on signs of respiratory distress that warrant immediate medical attention.

drskgupta@gmail.com

11/04/2024

सभी भारतवासीयों को ईद की राम राम & INDIA को सलाम

23/11/2022

17/11/2022

!! Dialysis Not Always Best Option in Advanced Kidney Disease, Conservative Management Is an Alternative Approach !!
- American Society of Nephrology

Hospitalization rates were higher in patients with advanced chronic kidney disease (CKD) treated with dialysis than those treated with conservative management, among those with an estimated glomerular filtration rate (eGFR) < 25 mL/min/1.73m2 and in most racial/ethnic groups, new research shows.

Patients mostly start dialysis because of unpleasant symptoms that cause suffering including high potassium levels and high levels of uremic toxins in the blood.
"Conservative management serves to address and manage these symptoms and levels of toxicities without dialysis, so conservative management is an alternative approach and patients should always be given a choice between [the two]," stressed Kalantar-Zadeh, professor of medicine at the University of California, Irvine.
The results were presented during Kidney Week 2022.
"There has been growing recognition of the importance of conservative nondialytic management as an alternative patient-centered treatment strategy for advanced kidney disease. However, conservative management remains under-utilized in the United States, which may in part be due to uncertainties regarding which patients will most benefit from dialysis versus nondialytic treatment," said first author Connie Rhee, MD, also of the University of California, Irvine.

"We hope that these findings and further research can help inform treatment options for patients, care partners, and providers in the shared decision-making process of conservative management versus dialysis," added Rhee, in a press release from the American Society of Nephrology.
Asked for comment, Sarah Davison, MD, noted that part of the Society's strategy is, in fact, to promote conservative kidney management (CKM) as a key component of integrated care for patients with kidney failure. Davison is professor of medicine and chair of the International Society Working Group for Kidney Supportive Care and Conservative Kidney Management.
"We've recognized for a long time that there are many patients for whom dialysis provides neither a survival advantage nor a quality of life advantage," she told Medscape Medical News.
"These patients tend to be those who have multiple morbidities, who are more frail, and who tend to be older, and in fact, the patients can live as long, if not longer, with better symptom management and better quality of life by not being on dialysis," she stressed.
Study Details

In the study, using data from the Optum Labs Data Warehouse, patients with advanced CKD were categorized according to whether or not they received conservative management, defined as those who did not receive dialysis within 2 years of the index eGFR (first eGFR < 25 mL/min/1.73m2), versus receipt of dialysis parsed as late versus early dialysis transition (eGFR < 15 vs ≥ 15 mL/min/1.73m2 at dialysis initiation).
Hospitalization rates were compared between those treated with conservative management compared with late or early dialysis.
"Among 309,188 advanced CKD patients who met eligibility [criteria], 55% of patients had ≥ 1 hospitalization(s) within 2 years of the index eGFR," the authors report. The most common causes of hospitalization among all patients were congestive heart failure, respiratory symptoms, or hypertension.
In most racial groups (non-Hispanic White, non-Hispanic Black, and Hispanic patients), patients on dialysis had higher hospitalization rates than those who received conservative management, and patients who started dialysis early (transitioned to dialysis at higher levels of kidney function) demonstrated the highest rates across all age groups compared with those who started dialysis late (transitioned to dialysis at lower levels of kidney function) or were treated with conservative management.
Among Asian patients, those on dialysis also had higher hospitalization rates than those receiving conservative management, but patients who started dialysis late had higher rates than those on early dialysis, especially in older age groups, possibly because they were sicker, Kalantar-Zadeh suggested.
Conservative Care Has Pros and Cons, but Canada Has Embraced it

As Kalantar-Zadeh explained, conservative management has its pros and cons compared with dialysis. "Conservative management requires that patients work with the multidisciplinary team including nephrologists, nutritionists, and others to try to manage CKD without dialysis, so it requires patient participation."
On the other hand, dialysis is both easier and more lucrative than conservative management, at least for nephrologists, as they are well-trained in dialysis care and it can be systematically applied. As to which patients with CKD might be optimal candidates for conservative management, Kalantar-Zadeh agreed this requires further study.
But he acknowledged that most nephrologists are not hugely supportive of conservative management because they are less well-trained in it and it is more time-consuming. The one promising change is a new model introduced in 2022, a value-based kidney care model, that if implemented will be more incentivizing for nephrologists to offer conservative care more widely.
Davison meanwhile believes the "vast majority" of nephrologists based in Canada — as she is — are "highly supportive" of CKM as an important modality.
"The challenge, however, is that many nephrologists remain unsure as to how to best deliver or optimize all aspects of CKM whether that is symptom management, advanced care planning, or how they must manage symptoms to align with a patient's goals," Davison explained.
"But it's not that they do not believe in the value of CKM."
Indeed, in her province, Alberta, nephrologists have been offering CKM for decades, and while they are currently standardizing care to make it easier to deliver, there is no financial incentive to offer dialysis over CKM.
"We are now seeing those elements of kidney supportive care as part of core competencies to manage any person with chronic illness including CKD," Davison said.
"So it's absolutely doable and contrary to one of the myths about CKM, it is not more time-consuming than dialysis

25/07/2022

1) Monkeypox, an orthopoxvirus, was first isolated in the late 1950s from a colony of monkeys. The virus is in the same genus as variola (causative agent of smallpox) and vaccinia viruses (the virus used in one of the available smallpox vaccines). It gets its name from an 1958 outbreak of the same among a group of laboratory test monkeys inside a research facility in Copenhagen . First human case was detected in 1970 .

2) Role of animals in spread – Its zoonotic disease . Man and monkey both are accidental hosts and wild rodents seems to be harbouring virus . The strain isolated from West Africa appears to be less virulent than the one from Central Africa. It’s clad 2 ie west African strain is spreading all over world .

3) How it spreads ? – Prolonged contact with animals (monkeys , squirrels , wild rodents etc ) or animal meat (wild animals) or close contact with infected humans . Primarily it doesn’t spread via air but if someone is in close contact with infected patient (> 3 hours , within 2 meters ) can get infection via large droplets . Secondary attack rates are around 7 percent . Its less infective than smallpox and chickenpox .

4) How to prevent spread ? – Isolate yourself to room for three weeks till all lesions scab and fall .

5) Incubation period - The incubation period of monkeypox virus infection is usually from 5 to 13 days but can range from 4 to 21 days. (Bite induces small incubation )

6) Symptoms –

a. Prodromal phase - typically lasts up to five days, is characterized by fever, intense headache, lymphadenopathy, back pain, myalgia, and severe fatigue. Swelling of the lymph nodes may be generalized (involving many different locations on the body) or localized to several areas.
b. Rash - The skin eruption usually begins within one to four days of appearance of fever and continues for a period of two to three weeks, although rashes without a prodrome have been reported . Rash is painful to start with but becomes itchy . The rash typically begins as 2 to 5 mm diameter macules.
subsequently evolve to papules, vesicles, and then pustules. Lesions are well circumscribed, deep seated, and often develop umbilication (a central depression on the top of the lesion) . Starts from face , palm and soles.
c. Multiple nonspecific laboratory findings can be seen in patients with monkeypox. These include abnormal aminotransferases, leukocytosis, thrombocytopenia, and hypoalbuminemia
d. DD from Chiken pox – in monkeypox lymadenopathy present , rash is of same age .
e. DD from small pox – in monkey pox presence of hepatomegaly
7) Treatment – Indicated - Those with severe disease and those at risk for severe disease (eg, those younger than eight years of age, pregnant or breastfeeding women, patients with complications of the infection, immunocompromised patients) . At this time, tecovirimat is the treatment of choice, although some experts may suggest dual therapy with tecovirimat and cidofovir in patients with severe disease.
8) If iam exposed to virus what I should do – Small pox vaccination if given within 4 days can prevent DISEASE . Although vaccination can be considered for up to 14 days of an exposure, if given between days 4 and 14, vaccination is thought to reduce the symptoms of disease but not prevent the disease
9) There are two available vaccines that can reduce the risk of developing monkeypox. The modified vaccinia Ankara (MVA) vaccine (JYNNEOS in the United States, IMVANEX in the European Union, and IMVAMUNE in Canada) and ACAM2000 vaccine.
10) Need not to panic – its self limiting disease with low mortality . Doesn’t leads to scarring unless immunocompromised . Those who were born before 1977 likely to have received small pox vaccination and should offer some protection . If no rash develops after 5 days of fever you can exclude monkey pox

23/05/2022

For the ongoing outbreak, see 2022 monkeypox outbreak.
Monkeypox is an infectious disease caused by the monkeypox virus that can occur in certain animals, including humans.[2] Symptoms begin with fever, headache, muscle pains, swollen lymph nodes, and feeling tired.[1] This is followed by a rash that forms blisters and crusts over.[1] The time from exposure to onset of symptoms is around 10 days.[1] The duration of symptoms is typically two to four weeks.[1]

23/01/2022

Postacute COVID syndrome (PACS), an ongoing inflammatory state following infection with SARS-CoV-2, is associated with greater risk of metabolic-associated fatty liver disease (MAFLD)