logging in or signing up Gulran Disease in Afghanistan 2008 jmofleh Download Post to : URL : Related Presentations : Share Add to Flag Embed Email Send to Blogs and Networks Add to Channel Uploaded from authorPOINT lite Insert YouTube videos in PowerPont slides with aS Desktop Copy embed code: (To copy code, click on the text box) Embed: URL: Thumbnail: WordPress Embed Customize Embed The presentation is successfully added In Your Favorites. Views: 49 Category: Education License: All Rights Reserved Like it (0) Dislike it (0) Added: September 06, 2011 This Presentation is Public Favorites: 0 Presentation Description This is a presentation about a rare disease in Afghanistan. Gulran disease is named after the district Gulran which is located in North west of Herat province of Afghanistan. This presentation is result of an outbreak invesitgation which is conducted by a team of DEWS officials in Afghanistan. Comments Posting comment... Premium member Presentation Transcript Overview of Gulran Disease : Overview of Gulran Disease Hepatic -veno-occlusive disease Dr. Jawad Mofleh Director for Disease Early Warning System/Surveillance Afghanistan Oct 2008 What is Gulran Disease? : What is Gulran Disease? Gulran Disease is a Hepatic Veno-occlusive Disease (VOD) First described in Gulran district in 1970s Gulran is a district located at north west of Herat, province, Afghanistan, bordering Iran and Turkemenstan Disease is associated with contamination of wheat by seeds from Heliotropium plants Outbreaks reported in 1970s,1990's and early 2000's What is Gulran Disease? : What is Gulran Disease? Heliotropium plants containing Pyrrolizidine Alkaloids (PA)* PA is a well-recognized cause of toxic liver injury and veno-occlusive disease (VOD) Other PA-containing plants have been responsible for outbreaks of VOD in Tajikistan, Iraq, India, Israel *Lancet, 1976 Aug 7; 269-71 Charmac Weed Plant : Charmac Weed Plant Charmac Weed Plant Charmact Seed Seeds mixed with wheat : Seeds mixed with wheat Charmac weed grows in wheat : Charmac weed grows in wheat Weed plant and seeds Charmac weed – leaves, roots, seeds : Charmac weed – leaves, roots, seeds Clinical Signs and Symptoms : Clinical Signs and Symptoms Toxic liver injury Hepatocellular haemorrhagic necrosis (destruction of liver tissue), accompanied by occlusion of the hepatic veins Abdominal pain, nausea, hepatomegaly, anorexia Massive ascites, emaciation Encephalopathy, death (up to 25%) Slide 9: Massive Ascitis(General Cachexia), picture courtesy Dr. Zarif Ahmad Akbrain, DEWS Officer, Western Region –Afghanistan 2008 Slide 10: Massive Ascitis, picture courtesy Dr. Zarif Ahmad Akbrain, DEWS Officer, Western Region –Afghanistan 2008 Slide 11: Massive Ascitis, picture courtesy Dr. Zarif Ahmad Akbrain, DEWS Officer, Western Region –Afghanistan 2008 Slide 12: Pedal Odema due to Hypoprotienemia, picture courtesy Dr. Zarif Ahmad Akbrain, DEWS Officer, Western Region –Afghanistan 2008 Outbreak of GD, 2007-08 : Outbreak of GD, 2007-08 1st cases reported Sep 07 from Qarabagh 228 cases and 25 deaths recorded in 43 villages CFR 11% 13% of villages of Gulran district is affected Initial investigation suggested charmac contamination of wheat Results-1 : Results-1 All cases expect one are from Gulran District 42 villages reported cases in the previous outbreaks as well A previously unaffected village near the Turkmenistan border had 4 cases this year for the first time These patients reported buying their wheat from near Qarabagh Result -2 : Result -2 Herat regional Hospital also reported cases of GD: Cases are not resident of Gulran Cases had no travel history to Gulran Reported consuming wheat from Gulran No other exposures from Gulran Results-3 : Results-3 From interviews with village elders: Charmac does not grow uniformly throughout Gulran District Cases of GD have occurred sporadically for > 50 years GD cases seem to occur near to where charmac grows Good wheat harvest in 2007 Where charmac grows heaviest, more cases have occurred Different varieties of charmac grow in different areas Some less/more toxic than others? Results-4 : Results-4 Conduct a case control study in 43 affected villages of the district 306 blood and food specimens collected and tested 21 out of 24 wheat flour samples were contaminated with the PA(toxic dose-different dose) None toxic dose of toxin was also found in Goat Milk, and Whey No toxin in water specimens were detected Charmac results : Charmac results Analysis of Qurut/whey : Analysis of Qurut/whey Slide 21: Winter started Measures for control of outbreak : Measures for control of outbreak Active case finding started-DEWS, MOPH Coordination team established-MOPH Food replacement and food distribution started through UNICEF, PRT, ARCS Establishment of a unit for treatment of cases-DEWS-MOPH Mass IEC campaign with the assistance of UNICEF Cash Distribution to the needy people-Govenor Office Herat Establishment of a Referral System of the patients to regional Hospital Implemented Measures after 1st reports : Development of a comprehensive plan for control of disease Deployment of two international Specialists from WHO and Government of Italy Refer of 17 patients to Kabul (capital of Afghanistan) for further investigation and treatment Implemented Measures after 1st reports Conclusion : Conclusion Gulran Disease is strongly associated with contaminated wheat flour with PA The disease has a seasonal pattern, most of the cases occur during winter while access to fresh vegetable and fruits are very limited Good wheat harvest are associated with higher number of cases Rich people are less likely to contract the disease Conclusion : Conclusion Consumption of food items e.g. fresh fruits, green vegetable, foods containing proteins and other high source of energy foods are negatively associated with the disease. Disease is located in a specific geographical area Disease can be eradicated by eliminating the seed of this weed plant from those area Animals e.g. goats are fed by this weed plant and the disease is not reported in the animal Co-authors : Co-authors Dr. Zarif Ahmad Akbarian, DEWS officer Afghanistan Dr. Rana Kakar, WHO-Afghanistan Slide 28: Questions You do not have the permission to view this presentation. In order to view it, please contact the author of the presentation.
Gulran Disease in Afghanistan 2008 jmofleh Download Post to : URL : Related Presentations : Share Add to Flag Embed Email Send to Blogs and Networks Add to Channel Uploaded from authorPOINT lite Insert YouTube videos in PowerPont slides with aS Desktop Copy embed code: (To copy code, click on the text box) Embed: URL: Thumbnail: WordPress Embed Customize Embed The presentation is successfully added In Your Favorites. Views: 49 Category: Education License: All Rights Reserved Like it (0) Dislike it (0) Added: September 06, 2011 This Presentation is Public Favorites: 0 Presentation Description This is a presentation about a rare disease in Afghanistan. Gulran disease is named after the district Gulran which is located in North west of Herat province of Afghanistan. This presentation is result of an outbreak invesitgation which is conducted by a team of DEWS officials in Afghanistan. Comments Posting comment... Premium member Presentation Transcript Overview of Gulran Disease : Overview of Gulran Disease Hepatic -veno-occlusive disease Dr. Jawad Mofleh Director for Disease Early Warning System/Surveillance Afghanistan Oct 2008 What is Gulran Disease? : What is Gulran Disease? Gulran Disease is a Hepatic Veno-occlusive Disease (VOD) First described in Gulran district in 1970s Gulran is a district located at north west of Herat, province, Afghanistan, bordering Iran and Turkemenstan Disease is associated with contamination of wheat by seeds from Heliotropium plants Outbreaks reported in 1970s,1990's and early 2000's What is Gulran Disease? : What is Gulran Disease? Heliotropium plants containing Pyrrolizidine Alkaloids (PA)* PA is a well-recognized cause of toxic liver injury and veno-occlusive disease (VOD) Other PA-containing plants have been responsible for outbreaks of VOD in Tajikistan, Iraq, India, Israel *Lancet, 1976 Aug 7; 269-71 Charmac Weed Plant : Charmac Weed Plant Charmac Weed Plant Charmact Seed Seeds mixed with wheat : Seeds mixed with wheat Charmac weed grows in wheat : Charmac weed grows in wheat Weed plant and seeds Charmac weed – leaves, roots, seeds : Charmac weed – leaves, roots, seeds Clinical Signs and Symptoms : Clinical Signs and Symptoms Toxic liver injury Hepatocellular haemorrhagic necrosis (destruction of liver tissue), accompanied by occlusion of the hepatic veins Abdominal pain, nausea, hepatomegaly, anorexia Massive ascites, emaciation Encephalopathy, death (up to 25%) Slide 9: Massive Ascitis(General Cachexia), picture courtesy Dr. Zarif Ahmad Akbrain, DEWS Officer, Western Region –Afghanistan 2008 Slide 10: Massive Ascitis, picture courtesy Dr. Zarif Ahmad Akbrain, DEWS Officer, Western Region –Afghanistan 2008 Slide 11: Massive Ascitis, picture courtesy Dr. Zarif Ahmad Akbrain, DEWS Officer, Western Region –Afghanistan 2008 Slide 12: Pedal Odema due to Hypoprotienemia, picture courtesy Dr. Zarif Ahmad Akbrain, DEWS Officer, Western Region –Afghanistan 2008 Outbreak of GD, 2007-08 : Outbreak of GD, 2007-08 1st cases reported Sep 07 from Qarabagh 228 cases and 25 deaths recorded in 43 villages CFR 11% 13% of villages of Gulran district is affected Initial investigation suggested charmac contamination of wheat Results-1 : Results-1 All cases expect one are from Gulran District 42 villages reported cases in the previous outbreaks as well A previously unaffected village near the Turkmenistan border had 4 cases this year for the first time These patients reported buying their wheat from near Qarabagh Result -2 : Result -2 Herat regional Hospital also reported cases of GD: Cases are not resident of Gulran Cases had no travel history to Gulran Reported consuming wheat from Gulran No other exposures from Gulran Results-3 : Results-3 From interviews with village elders: Charmac does not grow uniformly throughout Gulran District Cases of GD have occurred sporadically for > 50 years GD cases seem to occur near to where charmac grows Good wheat harvest in 2007 Where charmac grows heaviest, more cases have occurred Different varieties of charmac grow in different areas Some less/more toxic than others? Results-4 : Results-4 Conduct a case control study in 43 affected villages of the district 306 blood and food specimens collected and tested 21 out of 24 wheat flour samples were contaminated with the PA(toxic dose-different dose) None toxic dose of toxin was also found in Goat Milk, and Whey No toxin in water specimens were detected Charmac results : Charmac results Analysis of Qurut/whey : Analysis of Qurut/whey Slide 21: Winter started Measures for control of outbreak : Measures for control of outbreak Active case finding started-DEWS, MOPH Coordination team established-MOPH Food replacement and food distribution started through UNICEF, PRT, ARCS Establishment of a unit for treatment of cases-DEWS-MOPH Mass IEC campaign with the assistance of UNICEF Cash Distribution to the needy people-Govenor Office Herat Establishment of a Referral System of the patients to regional Hospital Implemented Measures after 1st reports : Development of a comprehensive plan for control of disease Deployment of two international Specialists from WHO and Government of Italy Refer of 17 patients to Kabul (capital of Afghanistan) for further investigation and treatment Implemented Measures after 1st reports Conclusion : Conclusion Gulran Disease is strongly associated with contaminated wheat flour with PA The disease has a seasonal pattern, most of the cases occur during winter while access to fresh vegetable and fruits are very limited Good wheat harvest are associated with higher number of cases Rich people are less likely to contract the disease Conclusion : Conclusion Consumption of food items e.g. fresh fruits, green vegetable, foods containing proteins and other high source of energy foods are negatively associated with the disease. Disease is located in a specific geographical area Disease can be eradicated by eliminating the seed of this weed plant from those area Animals e.g. goats are fed by this weed plant and the disease is not reported in the animal Co-authors : Co-authors Dr. Zarif Ahmad Akbarian, DEWS officer Afghanistan Dr. Rana Kakar, WHO-Afghanistan Slide 28: Questions