Based on study results and widely reported pleiotropic benefits, hydroxychloroquine could emerge as a potential drug for combination with statins for treatment of dyslipidemia. Long duration studies with larger sample sizes are required to further explore the role of hydroxychloroquine as adjunct to statins in reducing risk of cardiovascular events and prevention of statin-induced diabetes.

BackgroundSnake bites are a neglected public health problem in all tropical countries, and particularly in Malabar region of Kerala, India. Demographic characteristics and clinical parameters vary in this part of the world, and studies based on them are scarce. Increased incidence of capillary leak syndrome (CLS) in hemotoxic snake bites and emergence of cases of hump-nosed pit viper (HNPV, Hypnale hypnale) envenomation are some notable features seen here.ObjectivesThe study was conducted to assess the epidemiological profile and clinical features to identify factors contributing to outcome in patients with venomous snakebites.Materials and methodsAn observational cross-sectional study was done among patients with snakebite envenomation, admitted to Government Medical College, Kozhikode, Kerala, from January 2012 to October 2016.ResultsThere were 1,500 cases of toxic snake bites, of which 65% of these cases were males. Forty eight percent of them were aged between 21 and 40 years. Hemotoxic snake bites predominated, accounting for 912 cases. Viperine bite was the most commonly observed snakebite, and 70% of this was due to Russell’s viper and 25% due to HNPV. Among the neurotoxic bites, common krait bites predominated. Overall mortality was 8.8%. CLS was the major cause of death (80%). The mean dose of antivenom given for neuroparalytic snakebite was 10.25 vials, and 18.5 vials for hemotoxic bites. Albuminuria, neutrophilic leucocytosis, thrombocytopenia, acute kidney injury (AKI), and early onset of symptoms were associated with poor outcome.ConclusionThis study emphasizes the importance of snakebite as a significant threat to the community in the tropics. CLS in hemotoxic snake bites is the leading cause of mortality and is often refractory to any treatment measures. This study also brings to light the graveness of complications caused by HNPV envenomation. Anti-snake venom with activity against HNPV venom needs to be manufactured. Lack of awareness, delayed presentation to the hospital, and treatment by nonmedical personnel also add to the risk of mortality.

We conducted a serosurvey of 155 healthcare workers and 124 household and community members who had close contact with 18 patients who had laboratory-confirmed Nipah virus infections in Kerala, India. We detected 3 subclinical infections; 2 persons had IgM and IgG and 1 only IgM against Nipah virus.

Background An outbreak of Nipah virus (NiV) disease occurred in the Kozhikode district of Kerala State in India in May 2018. Several cases were treated at the emergency medicine department (ED) of the Government Medical College, Kozhikode (GMCK). The clinical manifestations and outcome of these cases are described. Methods The study included 12 cases treated in the ED of GMCK. Detailed clinical examination, laboratory investigations, and molecular testing for etiological diagnosis were performed. Results The median age of the patients was 30 years and the male to female ratio was 1.4:1.0. All the cases except the index case contracted the infection from hospitals. The median incubation period was 10 days, and the case fatality ratio was 83.3%. Ten (83.3%) patients had encephalitis and 9 out of 11 patients whose chest X-rays were obtained had bilateral infiltrates. Three patients had bradycardia and intractable hypotension requiring inotropes. Encephalitis, acute respiratory distress syndrome, and myocarditis were the clinical prototypes, but there were large overlaps between these. Ribavirin therapy was given to a subset of the patients. Although there was a 20% reduction in NiV encephalitis cases treated with the drug, the difference was not statistically significant. The outbreak ended soon after the introduction of total isolation of patients and barrier nursing. Conclusion The outbreak of NiV disease in Kozhikode in May 2018 presented as encephalitis, acute respiratory distress and myocarditis or combinations of these. The CFR was high. Ribavirin therapy was tried but no evidence for its benefit could be obtained.

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Necrotizing vasculitic neuropathy in polyarteritis nodosa can rarely present acutely and may mimic acute inflammatory neuropathies. A 53-year-old male presented with an acute neurological illness characterized by paresthesia and weakness of both lower limbs lasting six-days. He also had mild paresthesia of both hands. On examination, there were confluent, purpuric, and ecchymotic patches over the extensor aspects of both lower limbs, which were palpable. Neurological examination revealed grade II/V power with hypotonia and absent reflexes in the lower limbs. All modalities of sensation were decreased below the knee. Sensory impairment was also noted on the fingertips of both hands. Nerve conduction study suggested an asymmetrical sensorimotor axonal neuropathy. Sural nerve biopsy was consistent with necrotizing vasculitis. He was treated with intravenous methylprednisolone followed by oral prednisolone and monthly cyclophosphamide injection for six-months and made a good recovery.

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