ABSTRACT
Aluminium Phosphide (AlP) is a commonly used agricultural pesticide. It is cheap, effective, and easily available. Aluminium Phosphide is used as a rodenticide, insecticide, and fumigant to preserve stored cereal grains, also known as "Wheat pills". In Iran, it is known as the rice tablet. There, have been frequent incidents of accidental or intentional deaths. There have been only a few case reports on aluminum phosphide-induced pancreatitis in the literature available. In this report, we present the case of a young man who developed acute pancreatitis following ingestion of aluminum phosphide pellet in the absence of the usual risk factors and after exclusion of other possible causes of pancreatitis. 35-year-old male came to the ER of SGT Hospital, Gurugram, one hour after ingestion of a single 3 g tablet of Aluminium Phosphide (Celphos) at home, with a suicidal intent. He had three episodes of Vomiting on the way to the hospital. On Day 1 of admission, USG abdomen showed heterogeneity of head and the body of pancreas with minimal peri-pancreatic fluid, suggestive of Pancreatitis. Serum Amylase and lipase levels were raised throughout the hospital course. CT images were suggestive of pancreatitis. The signs and symptoms of Acute AlP Poisoning are non-specific, dose dependent and evolve with time. After ingestion, toxic features usually develop within a few minutes. The major lethal consequence of AlP ingestion is profound circulatory collapse, secondary to direct effects of toxins on cardiomyocytes, fluid loss, and adrenal gland damage. Our patient was diagnosed with acute pancreatitis in first 24hours of admission with high suspicion of pancreatitis and managed well with iv fluids and supportive treatment and was discharged after 3 weeks of in hospital stay.
ABSTRACT
Background: Rheumatoid arthritis (RA) is a chronic autoimmune systemic inflammatory multisystem disease of unknown cause that may affect many tissues and organs, but principally attacks synovial joints, primarily affecting the peripheral joints in a symmetrical pattern. The pathology of the disease process often leads to destruction of articular cartilage. It is the commonest inflammatory arthropathy worldwide with a gender predilection towards women. Prevalence of RA in the adult general population is approximately 1%. An association between RA and thyroid dysfunction with or without autoimmune origin has been reported in 6% to 34% of patients with RA. On the contrary, when presence of thyroid antibodies is considered, despite normal thyroid function, the prevalence can rise up to about 38%. These rates are significantly greater when compared with the general population.Methods: RA patients who were diagnosed according to the new 2010 EULAR/ACR criteria and thyroid function tests were done and patients with thyroid dysfunction were identified and then patients were divided into two groups based on presence of thyroid dysfunction with rheumatoid arthritis and disease activity was illustrated in both groups based on different scales.Results: In all, 250 patients 215 (86.8%) were females and 33 (13.2%) were males. ESR was elevated in 85 (34%) patients while as it was normal in 165(66%) patients. CRP was positive in 127 (52.7%) negative in 123 (47.3%) patients. Although subclinical hypothyroidism was the most frequent abnormality observed in 38.3% patients, only 30% had concomitant anti-TPO raised and 71.4% patients of overt hypothyroidism had raised anti-TPO antibody. Disease activity parameters were significantly higher in patients of RA with hypothyroidism as compared to other group. Although most of parameters of disease activity showed a higher frequency in the group having patients with thyroid disorder but the swollen joint count was comparable in both the groups and was not statistically significant.Conclusions: Presence of thyroid disorders in RA patients is suggestive of a more aggressive disease. To diagnose concurrent thyroid disorders at an earlier stage, routine measurement of serum thyroid- stimulating hormone is recommended in all RA patients at the time of diagnosis and with yearly interval thereafter.