Averting deaths in Muzaffarpur (All the children needed was a meal at night)

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 Averting deaths in Muzaffarpur (All the children needed was a meal at night)

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• Mystery diseases in Bihar 2012, '13, '14 : The outbreak of AES (Acute Encephalitis Syndrome) back then was actually "encephalopathy", and not encephalitis.
• The difference : Encephalities is a viral infection, in the brain. It is not easily treatable. Encephalopathy is a biochemical disease, not primarily in the brain. It is perfectly treatable!
• Hypoglycaemia : It is the low level of blood sugar, and can be normally corrected by taking oral sugar etc. But "hypoglycaemic encephalopathy" is totally different.
• Litchi, the culprit fruit : Muzaffarpur is full of litchi orchards, and the 2014 research showed that children would show symptoms in early morning, and then slip into a coma, and then die in a few days. In all cases, blood sugar level was below normal.
• What really happens : This is like the Jamaican Vomiting Disease, due to unripe ackee fruits. Litchi is of the same family.

1. The substance "methylene cyclopropyl alanine" present in that fruit blocks the process of glucogenesis (fatty acid oxidation) in human body. [Methylene cyclopropyl-alanine (MCPA) is known as hypoglycin A, and its analogue is Methylene cyclopropyl-glycine (MCPG) - both toxins]
2. First, the process starts, and then M-C-A blocks it. The molecules of the unfinished glucogenesis process are dangerous toxins (amino acids) for brain.

• Only malnourished children affected : Rich kids never fell ill, but poor families camping in litchi orchards did. Children pick up the fallen fruits and eat them. 

1. Many poor kids do not eat dinner. Their livers have poor reserve glycogen. In the morning, their blood sugar is anyway low (no dinner).
2. In the morning, the brain turns on glucogenesis as it needs glucose to function.
3. These poor kids eat Litchis (fallen to ground), previous day. The M-C-A gets to work. Now, with poor glucose levels already, sugar levels drop further, and aminoacidaemia develops. The disease begins (hypoglycaemic encephalopathy).

• How to prevent all this : Ensure that all children are well-nourished (impossible in short-term) and ensure they have a meal at night. Restrict litchi intake by children. Bihar managed to control the disease, but in 2019, it was a devastation yet again.
• Quick action needed : If ill kids are infused with 10% glucose within 4 hours of onset of brain dysfunction, they recover fully, not otherwise. But unfortunately, what was taught to the doctors back then, was forgotten, and operational issues overwhelmed the kids, killing scores!
• Summary : The children's deaths in Bihar in 2019 were entirely preventable, if only the lessons of 2014 were learned and remembered; sadly, they were not.

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