Hospitals Dealing with Dengue Viral Infections in Pakistan:
Heavy monsoon rains in Punjab has provided ideal conditions for dengue-carrying mosquitoes to thrive in stagnant waters. The number of Dengue Patients is constantly increasing. Seven patients lost their lives on 15th September 2011, while 5,500 Dengue cases have been confirmed in Punjab only. Out of 29 people who died of Dengue in Punjab, 25 were from Lahore, Geo News reported Friday, 16th September 2011.
Dr Farooqi said the government hospitals had accepted the challenge to cope with the situation but in case of increase in the number of patients, the services of private hospitals would be utilised. He said private hospitals would treat the dengue patients free of cost.
Ahmed Medical Complex, Sadiqabad, and Aziz Nursing Home had offered 30 beds each. While other hospitals including: Bilal Medical Centre offered 15 beds, Social Security Hospital 100 beds, Railway Hospital 16 beds and Islamabad International Medical College Hospital set aside 10 beds for the investigation and treatment of dengue patients.
Dengue Fever Treatment Costs:
A 15 days treatment of Dengue fever in Pakistani Hospitals can cost you around Rs. 102000. One mega unit of platelets, provided free at the public sector hospitals, costs Rs 15,000 to Rs 20,000 at private clinics.
Transfusion of more than one unit further increases the expenses of a private patient. Treatment of a dengue patient at a private hospital costs from Rs 50,000 to Rs 1 million depending upon the number of platelets kits.
Prevention of Dengue Viral Infections:
Dr. Akram stressed the need of an integrated vector control strategy. He said that mosquito sprays are not sufficient as we need a multiple approach for mosquito eradication, such as biological control, Larvicide, mass awareness, quarantine for patients and travel advisory. Guppy fishes are the best agent for the biological control of dengue mosquito.
There is also a need for larger clinical studies in Pakistan and other South Asian to better understand the range of infections, endemic patterns and genetic susceptibility of different populations to the dengue virus.
Private hospitals not serious about dengue virus
LAHORE - No government check on private hospitals in handling dengue patients has put several precious lives at risk, with health establishments across the provincial capital minting money with impunity, while the Punjab government is keeping mum over their “negligence”, Pakistan Today has learnt.
The death of 18-year-old Hamna Adeeb on the third day of Eid in National Hospital Defence has blown the lid off the unrestrained “mishandling” of dengue cases continuing in private health establishments even in posh areas of the metropolitan.
Hamna, an A-Levels student at LGS Paragon, was diagnosed with dengue on August 28. She was taken to National Hospital Defence regularly for treatment where doctors prescribed her with different medicines, but was never admitted or transfused blood.
“On Friday, we took her to National Hospital again where doctors on duty prescribed a drip of aspirin for her. Somehow I protested and did not let them give her aspirin. They however gave her some treatment and asked us to take her back but back home she collapsed after sometime. We rushed back to the hospital where she died,” Hamna’s father told Pakistan Today.
He further said, “No doctor asked us to admit her in the hospital or arrange blood for transfusion despite her being diagnosed with dengue. The specialists were not available because of Eid and we even tried to contact them on their cell phones but in vain. I could see that she was getting weaker with every passing day and only because of the doctor’s negligence I lost my daughter. The hospital administration has even taken detailed prescriptions after her death.”
The Health Department has already directed all private and public health establishments to report the number of dengue cases on a daily basis, however the private health establishments have been “hoodwinking” the government in reporting the figures.
A staffer in the National Hospital emergency, seeking anonymity, revealed that Hamna was brought twice to the emergency on Friday as per the hospital’s record. She said she had dengue and was attended by Dr Nighat. She further said the hospital administration had barred them to speak on the case to anyone from the media.
CDC Director Malik Mubashar said the government had issued directions to private and public hospitals to check the spreading epidemic, however, Hamna’s death was not reported to the government. He said National Hospital Defence, Ghurki Hospital, Surgimed Hospital and Ittefaq Hospital were all reporting cases on a daily basis but the death was not reported.
Health Secretary Jehanzeb Khan further said the issue of putting a check on private hospitals was very important and the government needed to get in and hold accountable those responsible for such negligence. He further said a meeting of all the heads of private hospitals will be called to find a solution to this problem. “There is no legal framework to fill the gap, as the government has asked them to monitor the dengue situation but more needs to be done to monitor the treatment facilities which should also be brought under check,” Khan added.
However, the hospital administration told Pakistan Today that Hamna was brought to the hospital only for 15 minutes and was put on a ventilator when she was pronounced dead. They claimed the family brought her to the hospital very late.
The death of 18-year-old Hamna Adeeb on the third day of Eid in National Hospital Defence has blown the lid off the unrestrained “mishandling” of dengue cases continuing in private health establishments even in posh areas of the metropolitan.
Hamna, an A-Levels student at LGS Paragon, was diagnosed with dengue on August 28. She was taken to National Hospital Defence regularly for treatment where doctors prescribed her with different medicines, but was never admitted or transfused blood.
“On Friday, we took her to National Hospital again where doctors on duty prescribed a drip of aspirin for her. Somehow I protested and did not let them give her aspirin. They however gave her some treatment and asked us to take her back but back home she collapsed after sometime. We rushed back to the hospital where she died,” Hamna’s father told Pakistan Today.
He further said, “No doctor asked us to admit her in the hospital or arrange blood for transfusion despite her being diagnosed with dengue. The specialists were not available because of Eid and we even tried to contact them on their cell phones but in vain. I could see that she was getting weaker with every passing day and only because of the doctor’s negligence I lost my daughter. The hospital administration has even taken detailed prescriptions after her death.”
The Health Department has already directed all private and public health establishments to report the number of dengue cases on a daily basis, however the private health establishments have been “hoodwinking” the government in reporting the figures.
A staffer in the National Hospital emergency, seeking anonymity, revealed that Hamna was brought twice to the emergency on Friday as per the hospital’s record. She said she had dengue and was attended by Dr Nighat. She further said the hospital administration had barred them to speak on the case to anyone from the media.
CDC Director Malik Mubashar said the government had issued directions to private and public hospitals to check the spreading epidemic, however, Hamna’s death was not reported to the government. He said National Hospital Defence, Ghurki Hospital, Surgimed Hospital and Ittefaq Hospital were all reporting cases on a daily basis but the death was not reported.
Health Secretary Jehanzeb Khan further said the issue of putting a check on private hospitals was very important and the government needed to get in and hold accountable those responsible for such negligence. He further said a meeting of all the heads of private hospitals will be called to find a solution to this problem. “There is no legal framework to fill the gap, as the government has asked them to monitor the dengue situation but more needs to be done to monitor the treatment facilities which should also be brought under check,” Khan added.
However, the hospital administration told Pakistan Today that Hamna was brought to the hospital only for 15 minutes and was put on a ventilator when she was pronounced dead. They claimed the family brought her to the hospital very late.
Infection of dengue fever
Dengue virus infection causes dengue fever (DF), dengue hemorrhagic fever (DHF), and dengue shock syndrome (DSS), whose pathogeneses are not clearly understood. Current hypotheses of antibody-dependent enhancement, virus virulence, and IFN-
/TNF
-mediated immunopathogenesis are insufficient to explain clinical manifestations of DHF/DSS such as thrombocytopenia and hemoconcentration. Dengue virus infection induces transient immune aberrant activation of CD4/CD8 ratio inversion and cytokine overproduction, and infection of endothelial cells and hepatocytes causes apoptosis and dysfunction of these cells. The coagulation and fibrinolysis systems are also activated after dengue virus infection. We propose a new hypothesis for the immunopathogenesis for dengue virus infection. The aberrant immune responses not only impair the immune response to clear the virus, but also result in overproduction of cytokines that affect monocytes, endothelial cells, and hepatocytes. Platelets are destroyed by crossreactive anti-platelet autoantibodies. Dengue-virus-induced vasculopathy and coagulopathy must be involved in the pathogenesis of hemorrhage, and the unbalance between coagulation and fibrinolysis activation increases the likelihood of severe hemorrhage in DHF/DSS. Hemostasis is maintained unless the dysregulation of coagulation and fibrinolysis persists. The overproduced IL-6 might play a crucial role in the enhanced production of anti-platelet or anti-endothelial cell autoantibodies, elevated levels of tPA, as well as a deficiency in coagulation. Capillary leakage is triggered by the dengue virus itself or by antibodies to its antigens. This immunopathogenesis of DHF/DSS can account for specific characteristics of clinical, pathologic, and epidemiological observations in dengue virus infection
