Deprecated (16384): The ArrayAccess methods will be removed in 4.0.0.Use getParam(), getData() and getQuery() instead. - /home/brlfuser/public_html/src/Controller/ArtileDetailController.php, line: 150
 You can disable deprecation warnings by setting `Error.errorLevel` to `E_ALL & ~E_USER_DEPRECATED` in your config/app.php. [CORE/src/Core/functions.php, line 311]
Code Context


        trigger_error($message, E_USER_DEPRECATED);

    }
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 You can disable deprecation warnings by setting `Error.errorLevel` to `E_ALL & ~E_USER_DEPRECATED` in your config/app.php.'
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deprecationWarning - CORE/src/Core/functions.php, line 311
Cake\Http\ServerRequest::offsetGet() - CORE/src/Http/ServerRequest.php, line 2421
App\Controller\ArtileDetailController::index() - APP/Controller/ArtileDetailController.php, line 150
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Cake\Http\ActionDispatcher::_invoke() - CORE/src/Http/ActionDispatcher.php, line 120
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Cake\Http\Runner::__invoke() - CORE/src/Http/Runner.php, line 65
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Cake\Http\Runner::__invoke() - CORE/src/Http/Runner.php, line 65
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Cake\Http\Runner::__invoke() - CORE/src/Http/Runner.php, line 65
Cake\Http\Runner::run() - CORE/src/Http/Runner.php, line 51
Cake\Http\Server::run() - CORE/src/Http/Server.php, line 98

Deprecated (16384): The ArrayAccess methods will be removed in 4.0.0.Use getParam(), getData() and getQuery() instead. - /home/brlfuser/public_html/src/Controller/ArtileDetailController.php, line: 151
 You can disable deprecation warnings by setting `Error.errorLevel` to `E_ALL & ~E_USER_DEPRECATED` in your config/app.php. [CORE/src/Core/functions.php, line 311]
Code Context


        trigger_error($message, E_USER_DEPRECATED);

    }
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 You can disable deprecation warnings by setting `Error.errorLevel` to `E_ALL & ~E_USER_DEPRECATED` in your config/app.php.'
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deprecationWarning - CORE/src/Core/functions.php, line 311
Cake\Http\ServerRequest::offsetGet() - CORE/src/Http/ServerRequest.php, line 2421
App\Controller\ArtileDetailController::index() - APP/Controller/ArtileDetailController.php, line 151
Cake\Controller\Controller::invokeAction() - CORE/src/Controller/Controller.php, line 610
Cake\Http\ActionDispatcher::_invoke() - CORE/src/Http/ActionDispatcher.php, line 120
Cake\Http\ActionDispatcher::dispatch() - CORE/src/Http/ActionDispatcher.php, line 94
Cake\Http\BaseApplication::__invoke() - CORE/src/Http/BaseApplication.php, line 235
Cake\Http\Runner::__invoke() - CORE/src/Http/Runner.php, line 65
Cake\Routing\Middleware\RoutingMiddleware::__invoke() - CORE/src/Routing/Middleware/RoutingMiddleware.php, line 162
Cake\Http\Runner::__invoke() - CORE/src/Http/Runner.php, line 65
Cake\Routing\Middleware\AssetMiddleware::__invoke() - CORE/src/Routing/Middleware/AssetMiddleware.php, line 97
Cake\Http\Runner::__invoke() - CORE/src/Http/Runner.php, line 65
Cake\Error\Middleware\ErrorHandlerMiddleware::__invoke() - CORE/src/Error/Middleware/ErrorHandlerMiddleware.php, line 96
Cake\Http\Runner::__invoke() - CORE/src/Http/Runner.php, line 65
Cake\Http\Runner::run() - CORE/src/Http/Runner.php, line 51
Cake\Http\Server::run() - CORE/src/Http/Server.php, line 98

Warning (512): Unable to emit headers. Headers sent in file=/home/brlfuser/public_html/vendor/cakephp/cakephp/src/Error/Debugger.php line=853 [CORE/src/Http/ResponseEmitter.php, line 48]
Code Context
            if (Configure::read('debug')) {

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        LATEST NEWS UPDATES | Averting deaths in Muzaffarpur -T Jacob John    </title>
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-The Hindu

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..."/>
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-The Hindu

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..." />
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                            <div align="justify">-The Hindu<br /><br /><em>All it would have taken was to ensure that the children had a meal at night<br /></em><br />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.<br /><br />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.<br /><br /><em>The disease pathway<br /></em><br />We found that the disease broke out during the months when litchi was harvested, i.e. April, May and June. Muzaffarpur is full of litchi orchards. The illness started suddenly &mdash; children were found vomiting, displayed abnormal movements, were semi-conscious, and were convulsing between 4 a.m. and 7 a.m. The disease progressed fast &mdash; children went into coma and died within a few days. When sick children were tested, the blood glucose level was always below normal.<br /><br />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.<br /><br />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.<br /><br />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.<br /><br />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.<br /><br />Please <a href="https://www.thehindu.com/opinion/op-ed/averting-deaths-in-muzaffarpur/article28067239.ece?homepage=true" title="https://www.thehindu.com/opinion/op-ed/averting-deaths-in-muzaffarpur/article28067239.ece?homepage=true">click here</a> to read more. <br /></div>                                                           
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    <br><a href="https://www.thehindu.com/opinion/op-ed/averting-deaths-in-muzaffarpur/article28067239.ece?homepage=true" class="re" target="_blank">The Hindu, 19 June, 2019, https://www.thehindu.com/opinion/op-ed/averting-deaths-in-muzaffarpur/article28067239.ece?homepage=true</a><div class="clear"></div>
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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..."/>
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All it would have taken was to ensure that the children had a meal at night

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    <h1 class="cat-box-title">Averting deaths in Muzaffarpur -T Jacob John</h1>
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                            <div align="justify">-The Hindu<br /><br /><em>All it would have taken was to ensure that the children had a meal at night<br /></em><br />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.<br /><br />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.<br /><br /><em>The disease pathway<br /></em><br />We found that the disease broke out during the months when litchi was harvested, i.e. April, May and June. Muzaffarpur is full of litchi orchards. The illness started suddenly &mdash; children were found vomiting, displayed abnormal movements, were semi-conscious, and were convulsing between 4 a.m. and 7 a.m. The disease progressed fast &mdash; children went into coma and died within a few days. When sick children were tested, the blood glucose level was always below normal.<br /><br />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.<br /><br />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.<br /><br />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.<br /><br />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.<br /><br />Please <a href="https://www.thehindu.com/opinion/op-ed/averting-deaths-in-muzaffarpur/article28067239.ece?homepage=true" title="https://www.thehindu.com/opinion/op-ed/averting-deaths-in-muzaffarpur/article28067239.ece?homepage=true">click here</a> to read more. <br /></div>                                                           
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    <br><a href="https://www.thehindu.com/opinion/op-ed/averting-deaths-in-muzaffarpur/article28067239.ece?homepage=true" class="re" target="_blank">The Hindu, 19 June, 2019, https://www.thehindu.com/opinion/op-ed/averting-deaths-in-muzaffarpur/article28067239.ece?homepage=true</a><div class="clear"></div>
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        LATEST NEWS UPDATES | Averting deaths in Muzaffarpur -T Jacob John    </title>
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-The Hindu

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..."/>
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-The Hindu

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..." />
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                            <div align="justify">-The Hindu<br /><br /><em>All it would have taken was to ensure that the children had a meal at night<br /></em><br />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.<br /><br />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.<br /><br /><em>The disease pathway<br /></em><br />We found that the disease broke out during the months when litchi was harvested, i.e. April, May and June. Muzaffarpur is full of litchi orchards. The illness started suddenly &mdash; children were found vomiting, displayed abnormal movements, were semi-conscious, and were convulsing between 4 a.m. and 7 a.m. The disease progressed fast &mdash; children went into coma and died within a few days. When sick children were tested, the blood glucose level was always below normal.<br /><br />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.<br /><br />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.<br /><br />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.<br /><br />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.<br /><br />Please <a href="https://www.thehindu.com/opinion/op-ed/averting-deaths-in-muzaffarpur/article28067239.ece?homepage=true" title="https://www.thehindu.com/opinion/op-ed/averting-deaths-in-muzaffarpur/article28067239.ece?homepage=true">click here</a> to read more. <br /></div>                                                           
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    <br><a href="https://www.thehindu.com/opinion/op-ed/averting-deaths-in-muzaffarpur/article28067239.ece?homepage=true" class="re" target="_blank">The Hindu, 19 June, 2019, https://www.thehindu.com/opinion/op-ed/averting-deaths-in-muzaffarpur/article28067239.ece?homepage=true</a><div class="clear"></div>
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Home हिन्दी

Averting deaths in Muzaffarpur -T Jacob John

Published on Jun 19, 2019   Modified on Jun 19, 2019

-The Hindu 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. The disease pathway We found that the disease broke out during the months when litchi was harvested, i.e. April, May and June. Muzaffarpur is full of litchi orchards. The illness started suddenly — children were found vomiting, displayed abnormal movements, were semi-conscious, and were convulsing between 4 a.m. and 7 a.m. The disease progressed fast — children went into coma and died within a few days. When sick children were tested, the blood glucose level was always below normal. 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. Please click here to read more.

The Hindu, 19 June, 2019, https://www.thehindu.com/opinion/op-ed/averting-deaths-in-muzaffarpur/article28067239.ece?homepage=true

Tagged with: Acute Encephalitis Syndrome Muzaffarpur Bihar Low Blood Sugar Sri Krishna Medical College Muzaffarpur Hypoglycaemic encephalopathy

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