DEATH TOLL IN KOREA DUE TO MERS REACHES 24.

Pulmonary Medicine Blog By Dr Deepu

The AP (6/19, Tong-Hyung) reports that World Health Organization Director-General Margaret Chan “praised beleaguered South Korean officials and exhausted health workers, saying their efforts to contain a deadly MERS virus outbreak have put the country on good footing and lowered the public risk.” So far, MERS “has killed 24 people and sickened more than 160 people in South Korea.” But, “the number of people isolated at home and in medical facilities declined from about 6,700 on Thursday to just more than 5,900 on Friday, with more than 5,500 people so far released from the quarantine, the Health Ministry said.”

        Meanwhile, Bloomberg News (6/18, Suwannakij, Blake) reported that on Thursday, Thailand’s Ministry of Health “confirmed that a Middle Eastern tourist seeking treatment at a Bangkok hospital has tested positive for” MERS in what is Thailand’s “first case of the virus.” The patient is a “75-year-old man” who “traveled to Thailand for treatment of heart disease at an unnamed private hospital on June 15, Health Minister Rajata Rajatanavin told reporters” yesterday.

        The AP (6/19, Doksone) reports that the patient displayed no “symptoms while traveling to Bangkok, but began to have fatigue and difficulty breathing after he was admitted to” the “hospital for treatment of his heart condition.”

        Reuters (6/19, Lefevre) points out that it took almost four days for Thai officials to make that confirmation. So far, 59 people are being monitored for the virus.

        CNN (6/18, Hanna, Parish) reports that Thailand is now “the 26th country with confirmed Middle East respiratory syndrome cases since the disease was identified in Saudi Arabia in 2012.”

Even Very Low level of air pollution may not be safe and can cause harm

Pulmonary Medicine Blog By Dr Deepu

Here is a bad news for all city dwellers. Even a very low levels of air pollution may not be safe, a new study reveals.

   Researchers studied all Medicare recipients in New England, using satellite data to rate short- and long-term exposure. They tracked daily air pollution from 2003 to 2008 and used Medicare data on residents older than 65 to calculate death rates. More than 550,000 people were included in the analysis, published in Environmental Health Perspectives.

   Generally, E.P.A. standards were met. But each 10 microgram per cubic meter increase in PM2.5 was associated with a 2.14 percent increase in death rate over a two-day period, and a 7.52 percent increase over a year.

   Even in rural areas like northern Maine, where the E.P.A. standard was consistently met, the results were similar. For each 10 microgram increase, there was a 2.14 percent higher death rate short-term, and 9.28 percent higher over a full year.

      The Environmental Protection Agency rates air pollution based on concentrations of particles smaller than 2.5 microns, or PM2.5. It generally regards as safe an annual average of 12 micrograms per cubic meter of air, or 35 micrograms per cubic meter over a one-day period.“The E.P.A. should tighten its standards,” said the lead author, Liuhua Shi, a doctoral student at the T.H. Chen Harvard School of Public Health, “and we need to reduce particles in the air, which we can do with off-the-shelf technologies.”

Proton Pump Inhibitors May Increase Heart Attack Risk

Pulmonary Medicine Blog By Dr Deepu

The New York Times (6/11, Bakalar) “Well” blog reports that research published in PLOS One suggests that “proton pump inhibitors...may increase the risk for heart attack.”

        The Washington Post (6/11, Bernstein) “To Your Health” blog reports that “after combing through 16 million electronic records of 2.9 million patients in two separate databases,” investigators “found that people who take the medication to suppress the release of stomach acid are 16 percent to 21 percent more likely to” experience a heart attack. Nicholas J. Leeper, an author of the study, “said the Food and Drug Administration ‘should be aware of these findings,’ but agreed that only a large, prospective clinical study...could establish whether the drugs are actually causing more heart attacks.”

        On its website, CBS News (6/11, Seidman) reports, however, that “analysis of patients using another type of antacid drugs called H2 blockers...did not show this increased risk.” The study received funding from The National Institutes of Health.

        Medscape (6/11, Pullen) reports that in an email to Medscape Medical News, Joel Rubenstein, MD, chair of the American Gastroenterological Association Institute Clinical Practice Section, wrote, “I would advise against making any changes in the management of patients based on this study. The results are intriguing and deserve further study. But the signal of an association is a weak one, and could easily be due to confounding by other factors, such as obesity, or due to initial misdiagnosis of angina as [gastroesophageal reflux disease].”

CDC To Issue Warning To US Physicians About MERS

Pulmonary Medicine Blog By Dr Deepu

David Muir reported on ABC World News (6/10, story 8, 1:05, Muir) that the CDC will issue a warning as early as tomorrow about “the deadly MERS virus.” The CDC is “sounding the alarm for American doctors now,” as more than 1,200 people have been infected around the world and the death toll is “approaching 500.” Richard Besser, MD, added that “the big concern is that the person who brought it into South Korea and spread it around hospitals might be something called a ‘super spreader’ – someone who can spread it to people easier than others.”

        The New York Times (6/11, Choe, Subscription Publication) reports, “With at least nine deaths, 122 confirmed cases and more than 3,400 who may have been exposed,” South Korea is now “experiencing an outbreak of MERS second in size only to that in Saudi Arabia, where it originated in 2012.” Yesterday, experts with the World Health Organization visiting that country “recommended that ‘all patients’ with fevers or respiratory symptoms be questioned about possible exposure to MERS.” The article also discusses the quarantine in place until June 18 in the village of Jangdeok where a case of MERS was reported. While villagers rail against the strict measures of the quarantine, people elsewhere in South Korea are voicing anger at the government for not doing more to contain the MERS outbreak.

        The Wall Street Journal (6/11, Kwaak, Gale, Subscription Publication) reports that fatality rates from MERS are significantly lower in South Korea than they have been in the Middle East. This week, the WHO disclosed that researchers around the globe are investigating if the MERS virus there has mutated.

        Meanwhile, the AP (6/11, Kim) reports that yesterday, “experts from the World Health Organization and South Korea...urged the reopening of more than 2,700 schools closed over fears” of the virus.

        In an opinion piece for CNN (6/10, Vox), physician journalist Ford Vox, MD points out that the US could learn some lessons from the outbreak of MERS in South Korea. Dr. Vox draws parallels to last year’s Ebola outbreak in Dallas, TX, in which poor communication and panic figured prominently. Currently, “South Korea is dealing with familiar problems of panic and insufficient guidance, but it is also putting into place some innovative new measures surrounding quarantine that our public health officials should consider,” such as “monitoring cell phone signals for those under quarantine and...using monitors who frequently call and check on those under quarantine.”

        The NPR (6/10, Hu) “Goats and Soda” blog and “All Things Considered” program focus on smartphone monitoring of people under quarantine orders. Focusing on the economic effects of the MERS outbreak in South Korea are the AP (6/11, Lee), Bloomberg News (6/11, Gale), and Reuters (6/11, Park, Kim).

SPOTTER : GIVE YOUR DIAGNOSIS

Pulmonary Medicine Blog By Dr Deepu

Mr X came to the out patient department with hemoptysis since 2 weeks, and chest pain in the right upper part anteriorly since 2 weeks. On questioning he further revealed weight loss since 2 months.
Chronic smoker with 60 pack years.
Examination revealed grade 3 clubbing. Clinical examination was normal.
This Chest X ray was taken.

1. What does the CXR show?
2. What is the differential diagnosis ?
3.  Diagnosis more likely?

4. Further Investigations required.

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