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Monday, January 27, 2020

Lassa Fever-West Africa

Image result for virus icons"Lassa fever is an animal-borne or zoonotic acute viral illness. It has been proven to be endemic in some countries in West Africa such as Sierra Leone, Liberia, Guinea and Nigeria. There is a high risk of the virus spreading in neighboring countries; also, the animal vector for the virus “multimammate rat” (Mastomys natalensis) can be distributed throughout the region (“Lassa Fever | CDC,” 2019).

 The virus was unidentified until the year 1969. The virus is a single-stranded RNA virus belonging to its family “Arenaviridae”.  An estimate of 80% of people who were infected by the virus do not present with the symptoms. About 1 in 5 infections can cause other medical complications as the virus affects other various organs that include liver, spleen and kidneys. Although the virus cannot be contaminated by air, it can be contagious through urine/faeces of the affected person or rat. It has been discovered that it is difficult to detect the virus in affected people because the clinical course of the virus is variable(World Health Organization, 2017).

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 Nigeria, Sierra Leone, Liberia, and Ghana have the majority of outbreak of the virus. The environment can also be at risk as a result of the population of rat in West and East Africa. There are 100,000-300,000 cases of Lassa fever each year around the world. Sierra Leone and Liberia are impacted the most with an estimate of 5,000 deaths in both countries and 10-16% of hospital admission per year. Children are more prone to the threat. Compared to Ebola Virus of 70% cases, Lassa fever has a fatality rate of 1% to a severe rate of 15%. “An unusually intense outbreak developed in early 2018 in Nigeria with over 300 confirmed positive cases reported in the month of March. Cases were reported in Bauchi, Plateau, Edo, Ondo, and Ebonyi States. Sixteen health workers, at least four of whom died, were diagnosed as of Mar. 4, 2018. Along with high numbers, case fatality rates for this outbreak exceeded 20%. A Weekly Epidemiological Report has been maintained by the Nigeria Centre for Disease Control.” The Nigerian Minister of Health, Professor Isaac Adewale, announced that vaccine against Lassa virus would be arriving by the end of 2018. Dr. Chikwe Ihekweazu, CEO of the Nigeria Centre for Disease Control, has stressed the important advances of improved awareness and expanded ability to test for Lassa fever virus in recent years. Dr. Ihekweazu has encouraged improved adherence to infection prevention measures and community sanitation efforts to control current and future outbreaks of Lassa fever. Lassa fever has rarely been diagnosed in the U.S. There have been only six diagnosed cases since 1969. The last case was diagnosed in May 2015, in New Jersey in a patient traveling from Liberia. U.S. cases have involved international travelers or immigrants who arrived with the infection after exposure to rodents in West Africa(Sandra Gonzalez Gompf, MD, 2019).

Lassa Fever | CDC. (2019). Retrieved January 27, 2020, from

Sandra Gonzalez Gompf, MD, F. (2019). (No Title).
World Health Organization. (2017). Lassa fever. Retrieved January 27, 2020, from

Thursday, January 23, 2020

The Coronary Virus Outbreak-An Epidemic in China

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World Health Organization have decided not to conclude on declaring the outbreak of a virus in china as a global health emergency. However, they are planning on meeting within some days to acknowledge the degree of the situation(“Coronavirus Live Updates: 1st Death Outside Epicenter Is Reported, but W.H.O. Doesn’t Declare Emergency Yet - The New York Times,” 2020).

The Chinese authorities enforced a lockdown protocol on five cities with an extraordinary effort of containing the outbreak of the virus which has threatened the health of people or made hundreds of people ill; and spread to other parts of the world. The authorities in China have closed transportation lines from Wuhan, the capital of Hubei province. Buses, subways, ferries, airport and train stations are suspended or shut down to any outgoing passengers. The Chinese cities of Huanggang and Ezhou have undertaken the same measures. Smaller cities of Chibi and Zhijiang have developed a travel restrictions(Kuo, 2020).

The Chinese Officials are trying to control the new virus that has spread in the country. There have been 9 casualties and 440 people are sick with the virus. It has been proven that the infection can be contagious among humans. The epidemic virus has spread from Thailand, Japan, South Korea, Taiwan to the United States of America. The Coronavirus was first detected in Wuhan, the central city of China (James Griffiths and Nectar Gan, 2020).  A research study in the United Kingdom estimated that the number of infections in Wuhan is being underestimated. The real number is closer to 1,700 which is based on the rate of exposure to the virus in other cities and countries within a short period of time. There was a case of fatality in the United States as a result of the virus on Tuesday the 22nd of January 2020 in Seattle.

The Ministry of Health and Community Protection has confirmed four cases in United Arab Emirates for Corona Virus. It is has been estimated that the virus has caused 132 fatality and infected about 6000 people across the world. A family of four who arrived in United Arab Emirates was found to be infected with the virus. The Ministry made announcement on Twitter that the infected people were Chinese citizens; and they are currently undergoing medical supervision. Also, the Ministry stated that the health of the infected people is stable. The Ministry emphasized that the epidemiological investigation centers in the country are constantly working to report any sign of virus (Nandkeolyar, 2020).

Moving on, the Romanian president of a Microbiology Society, Alexandru Rafila stated on Monday the 27th of January 2020 that the coronavirus is considered to be a public health emergency around the world according to the World Health Organization. Meanwhile, Dr. Adrian Streinu Cercel, manager of the “Matei Bals” Infectious Disease Institute has ensured Romania is not prone to the threat. About 70% of the cases in China have showed mild forms of the virus and the outbreak is mostly in China and not worldwide (Salceanu, 2020)

Coronavirus Live Updates: 1st Death Outside Epicenter Is Reported, but W.H.O. Doesn’t Declare  Emergency Yet - The New York Times. (2020). Retrieved January 23, 2020, from                       

James Griffiths and Nectar Gan. (2020). China confirms Wuhan virus can be spread by humans - CNN. Retrieved January 23, 2020, from

Kuo, L. (2020). China virus: five cities locked down and Beijing festivities scrapped | World news | The Guardian. Retrieved January 23, 2020, from

 Nandkeolyar, K. H. (2020). Coronavirus in UAE: Four of a family infected | Health – Gulf News. Retrieved January 29, 2020, from

Salceanu, D. (2020). Risk for coronavirus to reach Romania is low, healthcare experts say. Possible case in Romania refuted – The Romania Journal. Retrieved January 29, 2020, from

Friday, January 3, 2020

Patient Autonomy; Legal and Ethical Issues?

Image result for patients autonomyMedicine has been recognized over the years as an ethical based practice. Ethical foundation serves as a backbone for setting out a legal policy. Initially, medicine was more of a paternalistic norm which was practiced in the doctor-patient relationship-“a profession where physicians decides what treatment a patient should receive based on their experience and knowledge”; however, recently, the advancement in medicine has changed its concept to a “patient centered care”. This simply means that the healthcare provider only advises and informs the patient on the possible treatment, but the patient makes the decision. This shift from paternalism to patient-oriented care is merely a reflection on the changes of ethical principle in medicine (Brooks & Sullivan, 2002). Therefore, Patient Autonomy is defined as the patient’s right to make their own healthcare decisions without the interference of the physician. Through the aid of patient autonomy, healthcare providers are permitted to educate patients; yet, are not authorized to undermine the decision of the patient (Entwistle, Carter, Cribb, & McCaffery, 2010).  

Patient autonomy is the foundation of professional ethics in medicine. It is significant that a healthcare professional develops the ability to recognize and practice patient autonomy in its different ways (Murgic, Hébert, Sovic, & Pavlekovic, 2015). The respect for patient autonomy in the healthcare sector is a focus on situations where decisions are made based on medical interventions. The goal of autonomy is to provide the patient the right to make their own choices on their respective healthcare services; this is associated with the principle of confidentiality, fidelity, privacy and honesty that are invoked in decisions based on the principle of autonomy (Entwistle et al., 2010). Furthermore, to respect a patient’s autonomy is to yield to their judgement and ensure that they have the absolute freedom to choose without any objection. Therefore, the core values of autonomy is the appreciation for a person, which integrates two moral commitment to “honor autonomy and support those with developing; impaired or recede autonomy”(Nurmsoo, 2014) .

For the past decades, it has been emphasized that patients have had the right to self-determination in healthcare even though the healthcare providers concentrated on the promotion of clinical benefits for their respective patients. Medical benefits as a mandatory service, and the respect for autonomy have increased the tension between patient-physician relationship. The concept of autonomy compels general physicians (GPs) to respect the right of a patient; nonetheless, this makes it challenging for physicians to mitigate and prevent their patients from suffering. While on the other hand, the beneficence principle supports the physician to act according to the medical practice; yet, they refrain from being accused of “Big Brotherism”(Tore Nilstun And, 2000). The concept of autonomous inpatient decision making is centralized by the concept of providing an informed consent (IC) to the patient-to outline the legislative laws and other healthcare policies. To issue an informed consent to the patient, the decision made by them has to be based on the fact that the patient had the ability to make the decision, the physician provided adequate and relevant information to the decision maker, and finally, the decision made by the patient or the patient’s representative was not acted as a result threat or coercion (Kevin W. Coughlin, 2018)

Recent studies have indicated that patient autonomy is important to medical ethics. The findings of the study done by “Perspectives on Psychological Science, a journal of the Association for Psychological Science, psychological scientist Johan Ng”, demonstrated that patient autonomy can lead positive changes in healthcare. The results states that supporting the psychological needs of a patient is fundamental for physicians to help patients sustain their health and wellbeing (Ng, 2012).
The thesis statement, “patient autonomy is considered as a standard in the modern medicine and ethics; and patients are entitled to their healthcare rights from their respective physicians; however, patient autonomy can be biased from a physician’s point of view because  at the moment of treatment, the patient maybe impaired to make the right decisions for themselves”.

The beliefs, desires, and decisions of an individual are autonomous when a certain criterion has been met. For instance, if the person’s behavior was a result of weak will or compulsion, then this is known as “Heteronomous” and not “Autonomous”. If the individual has had external factors such as unreflect of socialization, manipulation, coercion; the decision of the person was not autonomous. Furthermore, if the beliefs of a person regarding a subject were false, inconsistent with each other, or the person had little or no information of the subject without their realization, then this is not considered as autonomy (Varelius, J., 2006).

 It has been argued by many that autonomy in the western medical care is treated as a means of obligation than the act of beneficence. Patient autonomy stands for administering care in accordance to the values and believes of the patient; it can also permit them to utilize their freedom for self-realization. While patient autonomy still has its high grounds and morale in places like the United States and Canada (Murgic et al., 2015), some Latin American cultures and Asian Societies still practice paternalism within their healthcare system. In the Latin American society, there is still a great significance in the number of physicians and families who believe in paternalism. For the purpose of assuring the health of the patient, most physicians may have the tendency to withhold information on the diagnosis and prognosis of the patient’s health condition in the form of beneficence. This can or may interfere of overrule the will of the patient (Karime K. Machado, 2012).  Also, in some cases, most of the physician does not participate in the decision making of the patient; however, it is the family of the patient who plays the role of a decision maker because the family’s autonomy and well-being is observed as more significant(Cheng-Tek Tai, 2003). Therefore, it can be considered that patient autonomy does not meet the cultural values of certain countries.
In patient autonomy, there is a constant risk of disconnection between the concept of self-determination and the need for a social medical system (Graber & Tansey, 2005). Patient autonomy involves a person to have the right of authorizing an informed decision about their medical treatment plan which simply means that they can set a limit for any medical intervention rendered to them. Moreover, this brings attention to the fact that patient autonomy can act as a threat to the duties of the healthcare professionals. This implies that physicians would have to go against their knowledge and believes to “save the lives of their patients” to ensure that their patients were well informed of the consequences or inconsequence of their healthcare decision (Evanthia Sakellari, 2003). The more the patient is autonomous over their own decisions, the more the physicians will suffer its consequences. Physicians request for a mental evaluation of a patient if the refusal to treatment was not based on a religion belief. For instance, patients who are cognitive impaired are usually incapable of determining their medical treatment in the context of their best interest. “A hospitalized patient of a medical history of schizophrenia   with a life-threatening; yet, a curable condition, who rejects any medical treatment because the voices in their heads are instructing them to decline the medication given to them by their physicians are likely to receive the necessary treatment for their recovery”(DT, 2019). To summarize, patient autonomy acts a challenge for healthcare providers to have a more professional conduct towards their patients.

Patient autonomy has influenced the doctor-patient relationship over the years. Doctor-patient relationship is crucial in the healthcare system; once it as been established, there must be a consistent commitment to provide an ongoing care to patients  which means that decision making has to be shared between the patient and physician throughout the incubation period of the disease. Furthermore, physicians are mandated by law and ethics to ensure that their patients receive the necessary care throughout the course of their medical condition, no matter the outcome or the challenge. On the other hand, patient autonomy brings about conflict of interest between the physician and the patient as it becomes medical and moral problem. To illustrate more, a cancer patient may decide not to follow-up with their medical intervention if they believe it may not be beneficial to their current health status; however, the physician may be obligated to provide that specific care to their respective patient because they have taken the oath of “do no harm”(Wancata & Hinshaw, 2016). The concept of patient autonomy becomes unsatisfactory in the terms of chronic diseases and primary medical due to the fact that there is a difference in the communication level between the physician and the patient, and that certain decisions may be insignificant compared to the maintenance of the relationship. Although patient autonomy should be respected in a strict manner, the healthcare system should pay a great amount of attention to the particularities of the patients or those who need medical services (Arrieta Valero, 2019).   

In conclusion, patient autonomy is seen as the ethical principle in medical practices. It plays an important role in the improvement and advancement of the quality of healthcare services that a patient receives. While ethics remains the backbone of legal policy, medicine which was initially a paternalistic norm is now transformed to a more patient-centered care. Even though physicians are required to understand and apply patient autonomy in its own various aspect, patient autonomy has proven to have a more negative impact towards the healthcare system. 

Arrieta Valero, I. (2019). Autonomies in Interaction: Dimensions of Patient Autonomy and Non-adherence to Treatment. Frontiers in Psychology, 10.
Brooks, H., & Sullivan, W. J. (2002). The importance of patient autonomy at birth. International Journal of Obstetric Anesthesia, Vol. 11, pp. 196–203.
Cheng-Tek Tai, M. (2003). The ethics of biobanking View project The St. Jude valve prosthesis. Evaluation and Followup View project. Retrieved from
DT, T. (2019). Jehovah’s Witnesses’ refusal of blood: obedience to scripture and religious conscience. J Med Ethics, 25(6), 469–472.
Entwistle, V. A., Carter, S. M., Cribb, A., & McCaffery, K. (2010, July). Supporting patient autonomy: The importance of clinician-patient relationships. Journal of General Internal Medicine, Vol. 25, pp. 741–745.
Evanthia Sakellari. (2003). (PDF) Patient’s autonomy and informed consent. (13). Retrieved from’s_autonomy_and_informed_consent
Graber, M. A., & Tansey, J. F. (2005). Autonomy, consent, and limiting healthcare costs. Journal of Medical Ethics, 31(7), 424–426.
Karime K. Machado, M. P. M. H. M. F. (2012). Autonomy Versus Paternalism in Latin America.
Kevin W. Coughlin. (2018). Medical decision-making in paediatrics: Infancy to adolescenceMedical decision-making in paediatrics: Infancy to adolescence | Canadian Paediatric Society. Canadian Paediatric Society, 23(2), 138–146. Retrieved from
Murgic, L., Hébert, P. C., Sovic, S., & Pavlekovic, G. (2015). Paternalism and autonomy: Views of patients and providers in a transitional (post-communist) country. BMC Medical Ethics, 16(1).
Ng, J. (2012). Supporting Patient Autonomy Is Critical to Improving Health – Association for Psychological Science – APS. Journal of the Association for Psychological Science. Retrieved from
Nurmsoo, S. M. (2014, September 16). Incidental findings and patient autonomy. CMAJ, Vol. 186, p. 1017.
Tore Nilstun And, S. B. (2000). Patients’ autonomy and medical benefit: ethical reasoning among GPs | Family Practice | Oxford Academic. Family Practice, 17(2), 124–128.
Varelius, J. (2006). The value of autonomy in medical ethics. Medicine, Health Care and Philosophy, 9(3), 377–388.

Wancata, L. M., & Hinshaw, D. B. (2016). Rethinking autonomy: decision making between patient and surgeon in advanced illnesses. Annals of Translational Medicine, 4(4).