Tuesday, June 20, 2017

Mr. Warmbier's confession opened the door to torture.

June 20, 2017

Cincinnati - A coroner's office in Ohio (click here) is investigating the death of a 22-year-old college student who died shortly after his return to the U.S. after nearly a year and a half in North Korean detention, a spokesman said Tuesday.

The spokesman for Hamilton County Coroner Dr. Lakshmi Sammaraco said the office "accepted the case" of Otto Warmbier, who died Monday in a Cincinnati hospital. Justin Weber told The Associated Press that a news conference is expected later to provide more information.

Wambier's parents did not cite a specific cause of death, but cited "awful, torturous mistreatment" by North Korea. Doctors had described Warmbier's condition as a state of "unresponsive wakefulness" and said he suffered a "severe neurological injury" of unknown cause....

The CDC.

These symptoms (click here) all result from muscle paralysis caused by the toxin. If untreated, the disease may progress and symptoms may worsen to cause paralysis of certain muscles, including those used in breathing and those in the arms, legs, and trunk (part of the body from the neck to the pelvis area, also called the torso). People with botulism may not show all of these symptoms at once.

Botulism is not associated with brain destruction. The symptoms are due to the muscles and nerve impulses, not the brain.

The WHO:

...Botulinum toxins (click here) block nerve functions and can lead to respiratory and muscular paralysis....

...Inhalation botulism
Inhalation botulism is rare and does not occur naturally, for example it is associated with accidental or intentional events (such as bioterrorism) which result in release of the toxins in aerosols. Inhalation botulism exhibits a similar clinical footprint to foodborne botulism. The median lethal dose for humans has been estimated at 2 nanograms of botulinum toxin per kilogram of bodyweight, which is approximately 3 times greater than in foodborne cases.
Following inhalation of the toxin, symptoms become visible between 1–3 days, with longer onset times for lower levels of intoxication. Symptoms proceed in a similar manner to ingestion of botulinum toxin and culminate in muscular paralysis and respiratory failure.

If exposure to the toxin via aerosol inhalation is suspected, additional exposure to the patient and others must be prevented. The patient's clothing must be removed and stored in plastic bags until it can be washed thoroughly with soap and water. The patient should shower and be decontaminated immediately....

Mr. Warmbier may have been exposed to botulism. It would be helpful if the WHO had statistics on botulism in North Korea. I doubt there are many modern day health statistics, but, there are probably some from the time of Kim Jong-Il. He was a better leader than his son has been. He had some affection for the people of North Korea. He allowed aid to the people so there maybe some understanding as to the health and illness (Morbidity and Mortality - click here) there.

August 1, 1986  / 35(30);490-1 Botulism antitoxin for patients (click here) with signs and symptoms of human foodborne or wound botulism is released to physicians by CDC from its quarantine stations located throughout the United States. Any health-care provider requesting botulism antitoxin should first contact his/her state health department. A list of daytime and 24-hour telephone numbers (if available) is published to assist those seeking botulism antitoxin (Table 2). If the state health department is unreachable during nights or on weekends, CDC may be called at (404) 329-2888 (24-hour number)

When botulism is suspected, a careful food history, especially for home-canned vegetables or fruits, should be sought, and the suspected food items, saved. Stool and serum should be obtained from patients with possible botulism and refrigerated. Electromyography should be done using repetitive stimulation at 40 Hz or greater. When indicated, cerebrospinal fluid should be examined for white blood cells and protein, and a Tensilon challenge test should be done. The patient's vital capacity should be monitored. The results of these tests are helpful in evaluating the need for botulism antitoxin. Reported by Enteric Diseases Br, Div of Bacterial Diseases, Center for Infectious Diseases, CDC.

I am looking forward to the coroner's findings.