Acute Methanol Toxicity: Clinical Correlation with Autopsy Findings, a Descriptive Study

Background: Methyl alcohol poisoning or deaths from drinking illegally brewed cheap alcohol which is often spiked with chemicals to increase its potency are frequent in India. Many outbreaks from different parts of the country have been reported from time to time. A total of 11,830 lives were lost between 2006 and 2015 due to the consumption of spurious liquor in the country. The symptoms can range from mild to severe depending upon factors like the amount of exposure and time of presentation. Aims and objectives: The present study was designed to describe the clinical presentation, management, and outcome of the patients during a recent methanol outbreak that can form a basis for diagnosis and management. This study also highlights the salient autopsy findings and their correlation with clinical features. Materials and methods: It is a retrospective, descriptive study discussing clinical features of patients with methanol intoxication, their outcome, and the clinical correlation with autopsy findings of patients who succumbed to death. The study was conducted at King George’s Medical University, Lucknow. The patients were enrolled from a methanol intoxication outbreak in Barabanki district on 28th May 2019 followed by a similar outbreak in Sitapur district two days later. Results: A total of 33 patients were included in this study based on predefined clinical characteristics. The average amount of alcohol consumed was about 223 mL (range: 100–300 mL). The majority of patients had onset of symptoms between 12 and 24 hours. All patients had gastrointestinal symptoms, 97% of patients had visual disturbances, 91% of patients had central nervous system manifestation while frank coma was observed in 15% of patients. Decreased urine output was reported in 6% of patients. About 90% of patients had metabolic acidosis. Out of 33 patients included in this study, 30 patients were discharged in stable condition while two died and one absconded. Autopsy findings revealed marked cerebral edema and hyperemia, hyperemic heart, and congested lungs in all the patients. One patient showed putaminal necrosis which is characteristic of methanol poisoning. Kidneys in two cases were hyperemic and show parenchymal degeneration which co-relates with both patients being anuric. Conclusion: Methanol intoxication is a serious problem in developing countries like ours. Timely intervention is an important factor in reducing mortality among these patients. The study highlights the very important fact that methanol intoxication can be managed at the very ground level with minimal resources (as available) if intervened and recognized in time.

An observational study to determine the incidence and the clinico-epidemiologic profile of dengue fever in paediatric age group presenting to a tertiary care centre in Western Rajasthan, India

Background: Dengue remains major public health concern because of the expanding geographic distribution of both the virus and the mosquito vector. Aims and objectives was to determine the incidence of dengue fever in paediatric age group presenting to a tertiary care centre in Western Rajasthan and to evaluate the clinico-epidemiologic profile of these children.Methods: This is observational epidemiological study on patients of pediatric age group, over a period of one year.Results: A total of 210 ELISA positive cases, comprising of 55% males and 45% female (Male to female ratio of 1.2:1) were enrolled. In this study most (44.7%) were age group of 10-18 years, 80% patients from urban area, 93.8%. admitted between the months of September to December, 70.95% presented between 3rd to 5th days of their illness, 48 (22.86%) were tourniquet test positive at the time of admission with fever being most common (95.23%) presenting symptom, followed by headache (60%) and vomiting (55%). Almost all (99.52%) had thrombocytopenia (34.2% of them had severe thrombocytopenia), most (85%) had a hospital stay of less than a week, 98.10% patients required fluid therapy for less than 5 days. and a mean of 3.41'2.60 days were required by these patients to recover from significant thrombocytopenia. Here 22% (46) patient's required ICU care, with shock being main indication for ICU admission, followed by requirement of blood product transfusion (73%). Bleeding manifestations were seen in '73(34%) patients, commonest being the epistaxis in 40 patients (55%).Conclusions: Incidence of dengue was 0.42% with 32.38%patients were IgG ELISA positive also.

Indoor potted plant based biofilter: performance evaluation and kinetics study

Plant based biofilters associated with microorganisms have been gaining popularity in controlling odorous compounds like volatile organic compounds (VOCs) as they are cost effective and an environment friendly alternative to conventional air pollution control techniques. In this context, here, we tried to evaluate the performance of potted plants based Claire’s biofilter for biodegradation of benzene. A sealed perspex chamber with lid and fan was designed to ensure minimum leakage, proper aeration and distribution of benzene inside the chamber. Five different ornamental indoor plants were placed inside the chamber sequentially and exposed to a concentration of 5 ppm benzene for 30 h each. The leakage of benzene was checked beforehand. Epipremnum aureum (Money plant) showed maximum benzene degradation in the aforementioned time period with a removal efficiency of 98%. The µmax and Ks values for 100 ppm concentration of benzene were calculated to be 0.284 h-1 and 0.427 g/m3, respectively.

Sixth cervical vertebra with bilateral double foramen transversarium and non-bifid spine: a rare case.

Anatomical knowledge of variations is of utmost clinical importance to all of us as they may be one of the reasons as etiological as well as of surgical importance. Vertebral region also presents many variations. Foramen transversarium are typical feature of cervical vertebrae and give way to neurovascular bundle, like vertebral artery, vertebral veins and sympathetic plexus around them throughout. Foramen transversarium and spine or spinous process of cervical vertebrae are important to all of medical specialists as well as for surgeons specially the surgeons dealing with head & neck surgeries. Knowledge of anatomical/surgical variations is very important for neurosurgeons and radiologists for reporting and planning for surgeries as this type of variation if ignored may be a cause for fatal or undesirable outcome of the surgical procedure or may lead to a different planning/approach at the time or during the surgical procedure. In the present case we observed very uncommon finding of bilateral double foramen transversarium as well as a nonbifid spinous process in sixth cervical vertebra which is extremely rare. Right and left both main foramen transversarium were bilateral symmetrical and rounded in shape. Right accessory foramen transversarium was complete while left was incomplete. Finding of present study is important in neurosurgery for posterior approaches of the cervical vertebrae and also useful for radiological studies to avoid erroneous counting of cervical spines in clinical observations as surface landmark.

Pseudoseizures: Any Psychosocial Determinants.

A sample of 80 subjects; 15 male and 65 female in age group of 5 to 45 years well educated; were diagnosed for pseudo-seizures in Neurology OPD and were included in the study. Subjects were excluded who were with any psychiatric or major physical illness. The patients, as the diagnosed case of pseudo seizures, were referred for psychosocial evaluation and were included in the study. Several sessions were held with such patients, their family members and friends to explore the psychosocial stressors as well as secondary gain if any. We observed no significant difference in relation to marital, socioeconomic and educational status among the males and females. But there were significant differences in the findings of the study in relation to the sociodemographic profile of the patients in relation to age, marital status, education and occupation of the patients. Other variables like gender, socio economic status, habitat, religion and family did not reveal any significant difference. These results are in conformity to other reported studies on patients with pseudoseizures, who have a number of stressors i.e. financial burden, family conflicts, marital disharmony, love affairs, disruption in career related issues and academic failure etc.