ABSTRACT
Fluorosis is a public health problem that is caused by excess intake of fluoride through ground/deep bore water. It gets deposited in the bones, teeth, and soft tissues. Fluoride in the human body acts as a “double-edged sword.” Fluoride is beneficial in small amounts but toxic in large amounts. People who have consumed 10–20 mg of fluoride per day for more than 10–20 years may develop crippling skeletal fluorosis. Stiffness and pain in the major joints, including the neck, back, hips, and knees, reduce mobility. The bone structure may change and ligaments may calcify in extreme cases, resulting in muscular weakness and pain. Here, we have reported a case of chronic quadriparesis due to compressive cervical myelopathy. After extensive workup, diagnosis of skeletal fluorosis was made.
ABSTRACT
Celphos poisoning (trade name of aluminium phosphide) is a large, though under-reported, problem in the Indian subcontinent. Methods: The study was conducted at the Intensive Care Unit (ICU) of a tertiary care teaching hospital of central India. Data were collected by a retrospective chart review of all patients admitted from February 2010 to February 2014 with a diagnosis of celphos poisoning. Results: Fifty patients (32 females, 18 males) were registered from the 967 patients of poisoning admitted to the ICU during the same period, of whom 44 (88%) had died (non-survivors) and the remaining 6 (12%) had survived. Forty five cases were of suicidal poisoning, and 5 were of accidental poisoning. Majority [42/50 (84%)] were from rural background. The ingested dose was 7.23 ± 1.28 gram among non-survivors and 3.3 ± 1.9 gram among survivors. Conclusion: Strict implementation of nationwide pesticide regulation, including restricting the availability of poison, being aware of its toxicity and providing improved medical management in consultation with regional or national poison control centers could further reduce the mortality due to ALP toxicity as there is no antidote available presently.
ABSTRACT
Objective: To compare the safety and efficacy of the long-acting analog insulin glargine and human premix insulin in patients with type 2 diabetes who were previously treated with oral hypoglycemic drugs alone but inadequately controlled. Research design and methods: A total of 750 subjects with type 2 diabetes who were receiving oral hypoglycemic drugs for diabetes control were randomized to receive insulin glargine once-daily (n = 370) or human premix insulin twice-daily (n = 380) for 24 weeks in an open-label, tertiary center study. Doses were adjusted systematically to obtain target fasting glucose <100 mg/dl. Outcomes included fasting blood sugar, glycosyloted hemoglobin (HbA1C) levels, change in weight and insulin dose from study start to end. Results: At the start of study, age range was 30-70 years, BMI was 26.48 ± 6.3 kg/m2 and HbA1C was 11.9 ± 3.1% (mean ± SD) for both groups. The mean change (means ± SD) in HbA1C from baseline to endpoint was similar in the insulin glargine group (−3.0 ± 1.68%) and the human premix insulin group (−2.89 ± 1.79%) (p = 0.3861). The symptomatic hypoglycemic episodes were greater with human premix insulin than with glargine (significance level 0.00002). Subjects in the insulin glargine group experienced less weight gain than those in the premix human insulin group (0.4 vs 1.4 kg, p < 0.0001). Conclusions: In patients with type 2 diabetes, once-daily bedtime insulin glargine is as effective as twice-daily human premix insulin in improving and maintaining glycemia control. In addition, insulin glargine demonstrates a lower risk of symptomatic hypoglycemia and less weight gain compared with human premix insulin. The treatments were associated with similar reductions in fasting glucose levels and HbA1C levels.