Dr C. H. S. Mani

Good film which will take you to your college days. Darsana had ACTED well, with excellent real life like facial expressions Pranav had done the mallu image in college life beautifully and acted well Photography is very good

VIRUS. (Nipah) Saw the Malayalam film. Good. I rate it 5/5 My appreciatons to the producer. Sir, Your film helps all to have a live visual experience of Nipah To me, it was thought provoking experience. Medical professionals / students can update their knowledge easily by watching. Layman can get an idea of what to do and what not to do The last scene is the take home message. He saved a bat-baby or bat-pup and (possibly) acquired the infection by DIRECT physical contact with reservoir. The whole film convey's to me and made me think like this It took 2 to 3 weeks to develop the first symptoms The symptoms Fever, Cough, Breathing difficulty, Severe Headache, (High BP) Vomiting and Altered sensorium The Signs and probable pathophysiology Rapid progression to Respiratory distress which causes oxygen desaturation eventually leading to cerebral hypoxia and convulsions AND / OR Lung pathology with or without ARDS leading to (hypoxia) hypercarbia leading to increased cerebral blood flow (severe headache) eventually increase the intracranial tension (protracted vomiting) Direct attack of lung and brain leading to ARDS & encephalitis respectively. Encephalitis eventually leading to altered sensorium and seizures It was thought provoking. 1. In the film, the index person had a direct contact with baby bat. If there's no contact with bat, what are other possibilities (mode of transmission) 2. Bat bitten fruits (mangoes) were seen lying on the ground. So one source is saliva, others may be other body fluids (urine) 3. Human to human transmission may be by 1. Coughed droplets 2. Contaminated Vomitus 4. Using a handkerchief during coughing will prevent droplet infection. (But it seems the patients are too sick to use a handkerchief, practically impossible) 5. Vomiting can be collected in a plastic bag. But the nature of vomiting seems to be due to raised ICT. In that case likely to be difficult to collect safely. 6. The virus seems to have a prediliction to lungs and cerebrum. 7. Another possibility is multiplication in gastric mucosa, get vomited, aspiration into lungs leading to ARDS & Oxygen desaturation eventually resulting in seizures. And spread from lungs to brain through viremia and causing encephalitis. 8. The increase in the BP to stage 3 level may be due to the hypoxemia and hypercarbia which can be effectively controlled by ventilation. 9. One nurse demanded intubation but the non-anesthetist doctor didn't get her concept. I perceive that she had prior ICU experience and she had a gut feeling that her airway need to be protected and her respiration supported. If I were there and a ventilator was available I would have definitely intubated and ventilated her. 10. Endotracheal intubation after muscle paralysis and controlled mechanical ventilation - help improve oxygen saturation - help decrease hypercarbia - helps to decrease raised ICT - controls seizure immediately - protects the lungs from aspiration of vomitus - help decrease work of breathing What could be the cause of death? Hypoxia? Raised ICT? CONING? Still thinking.... Searching literature Any postmortem reports suggestive of coning? Cause of death?