SARS revisited
Girish Bhaskar
SARS (Severe acute respiratory syndrome), which started in China last winter rapidly, spread to many countries taking a death toll of 813. Worldwide 8437 people were infected. Main outbreaks were reported from China, Hong Kong, Toronto, Singapore, Taiwan and Viet Nam. 73 cases of SARS were reported in the United States with no death. The death rates from SARS pales in comparison with the global death rates for AIDS, Tuberculosis and Malaria. 3.1 million died of AIDS and 2 million each from Tuberculosis and malaria.

SARS took a heavy toll on health care workers. Nearly a quarter of all patients with SARS in Hong Kong was health care workers. In Canada 65% of SARS cases involved health care workers.

Much has been learned about SARS virus. It is identified as a novel corona virus and its viral genomes have been sequenced. A diagnostic blood test is available in special laboratories around the world. The incubation period is 2 to 10 days and close contact is important in the spread of the disease. The virus can be found in the sputum, tears, blood, urine and feces. The spread of the virus is usually by air borne particles. The SARS virus symptoms can be confused with flu (Influenza) virus. Since both occur during winter months, to reduce the confusion, Center for Disease control recommends flu vaccination this season.

The spread of SARS occurs when a case is not suspected early on and then there is a potential to spread the disease among health care workers. An important lesson learned from the last year's SARS outbreak is that with strict infection control measures, the spread of the disease can be contained. Health care workers should use gowns, gloves, face shields and N95 facemasks. Cases should be managed in negative air pressure rooms. Meticulous hand washing is essential between all patient contacts and even after removing gloves. Patients with SARS should not be allowed to donate blood for al least 6 weeks after illness. Patient to patient spread of SARS from an initially unrecognized case remains a big challenge. Rapid diagnostic tests with early isolation of the confirmed cases are extremely important. Even with accelerated efforts, a vaccine for SARS virus may take a minimum of two years.

Anyone exposed to SARS virus must be quarantined and should remain isolated for 10 days. This applies to health care workers also. 20% of the infected cases of SARS require care in intensive care units and the death toll in this subset of SARS patients is about 60%.

Warm weather and an element of luck saved India from a major outbreak last year. For India the best course will be a heightened awareness of the disease especially at airports and isolate all suspected cases from public contact for 10 days.

Majority of experts at WHO (World Health Organization) believe SARS could come back this winter. One million cases of flu are expected this winter worldwide. Because the SARS blood test can give false positive test results, countries that have a low risk for SARS like USA and India should use the tests only as a last measure. But places like South China, Hong Kong or Toronto should test for the SARS virus as soon as a cluster of atypical pneumonia appears. Positive results will be verified in one of six regional laboratories 'WHO' is setting up world wide including the CDC in Atlanta. Further information on SARS can be found at the CDC web site. The site offers a wealth of information for physicians and general Public.

Good survival rates for liver cancer patients
Undergoing Transplant
More than 60 percent of liver transplant patients with advanced liver cancer are still alive after five years, compared to nearly zero survival for those patients who did not undergo transplant, according to a study by Johns Hopkins researchers.

According to Paul Thuluvath, M.D., lead author of the report published in the December issue of the Journal of Clinical Oncology, This is good news for patients with liver cancer. If diagnosed early, transplantation is the treatment of choice for patients with liver cancer and advanced cirrhosis. Thuluvath emphasizes that regular screening of patients with cirrhosis, a risk factor for liver cancer, is needed to detect the cancer early and ensure the best possible outcome.

In addition to the favorable five-year survival rates, Thuluvath and colleagues found that survival rates increased steadily over the last decade, suggesting that criteria for patient selection established by other experts may assist physicians in selecting those patients most likely to respond well to the procedure.

Study confirms benefits of Hemispherectomy Surgery
A new study by Johns Hopkins scientists confirms the lasting benefits of hemispherectomy, a dramatic operation in which half the brain is removed to relieve frequent severe seizures that medications cannot control. Results of the study, published in the Oct. 14 issue of Neurology, show that 86 percent of the 111 children who underwent hemispherectomy at Johns Hopkins between 1975 and 2001 are either seizure-free or have non-disabling seizures that do not require medication. These results are slightly improved over a 1997 study of 58 Hopkins hemispherectomy patients which found that 78 percent of children were either seizure-free or had mild seizures.

The findings should help parents who are still contemplating whether their child would benefit from the surgery, said the study's lead author, Eric Kossoff, M.D. "It's clear now that the quality of life of children with chronic, severe seizures greatly improves following hemispherectomy," he said. "In almost all cases, the children no longer depend on multiple medications, and post-operatively, most of the children are walking and running and living normal lives." All hemispherectomy patients have partial paralysis on the side of the body opposite the removed portion. However, "except for a few with major postoperative complications, such as meningitis and edema, all the children we followed up with are up and about and most have adapted to their handicapped side so well that they play the piano, golf, ping-pong and can dance," Kossoff added.