What influences outcome of patients with suicidal hanging.

AIM: Suicidal hanging is an uncommon medical emergency with significant neurological morbidity. The aim of the study was to identify factors that have a bearing on the final outcome. MATERIALS AND METHODS: Retrospective analysis of 37 consecutive cases of suicidal hanging admitted to our ICU from July 1996 - December 2002 was performed. Outcome at discharge was defined as good (complete neurological recovery) or poor (death or incomplete neurological recovery). Three clinical variables (at presentation) namely Glasgow Coma Scale (GCS) at presentation, time lapse (in hours) from the incident to arrival at our hospital and the presence of Hypotension (defined as a systolic blood pressure < or = 90 mm Hg) at admission were recorded and tested individually for an association with the outcome. Statistical analysis was done using the Odds ratio (OR +/- 95% Confidence Intervals) and Chi-square test of significance for categorical data. RESULTS: Patients with suicidal hanging constituted < 1% of ICU admissions (mean age 27 years). 34/37 survived giving a survival rate of 92%. Of those who survived, 31 patients (91%) had complete neurological recovery at the time of discharge from hospital. Among those who presented <4 hours of the incident (25 patients), 2 had an adverse outcome as compared to 4/10 patients who presented 4 hours or more after the incident (OR 7.6,95% CI 1.12-52.3). A low GCS (GCS <7) at presentation was also statistically associated with a poor outcome (OR 10.4, 95% CI 1.08-102.1). Hypotension was present in approximately 33% of patients (12/37) at presentation. Of these 12 patients, 3 had an adverse outcome as opposed to 3 patients among the remaining 25 (OR 1.6, 95% CI 0.41 - 14.47, NS). CONCLUSIONS: Suicidal hanging is an unusual medical emergency that is common among young individuals in developing countries. Our study indicates that a delayed presentation to a medical facility and a low GCS at presentation predict a poor outcome.

Rodenticide-induced hepatotoxicity.

Hepatotoxicity following acute poisoning with rodenticides has been infrequently reported in literature. To emphasize the fact that this form of clinical presentation is not unusual we are reporting two cases of rodenticide poisoning masquerading as severe hepatic dysfunction.

ESR and iron status in pregnancy.

ESR (Westergen) correlated significantly with the iron status (as measured by Hb concentration, haematocrit, red cell count, MCH, P/H ratio, serum iron, TIBC and percent saturation of transferrin) in a group of pregnant women (PW) at term. Serum ferritin correlated negatively with the ESR but the correlation was not statistically significant. Serum ferritin levels of < 50 micrograms/L were present in 9 (34.6%) PW with ESR > or = 50 mm 1st hour and 5 (19.2%) PW with ESR < 50 mm 1st hour. The mean ESR in PW was 55.7 (+/- 22.9) and was > or = 50 mm 1st hour in 50% and < 75 mm 1st hour in 82.7%. The difference in the mean ESR in anaemic and nonanaemic PW was highly significant (p < 0.001), 87.5% anaemic PW with serum ferritin > 50 micrograms/L had ESR > or = 50 mm 1st hour, suggesting the possible effect of chronic infection in raising ferritin levels in these PW.

Comparison of cardiovascular risk factors in type II (non-insulin dependent) diabetics with and without coronary heart disease.

Cardiovascular risk factors in NIDDM were studied by comparing 175 subjects with coronary heart disease (CHD) to 173 subjects without CHD; both groups were matched with regard to male to female ratio, age at diagnosis of diabetes and body mass index. The risk factors included were hypertension, poor metabolic control, smoking and lipid abnormalities. Since the mean known duration of diabetes in subjects with CHD was longer compared to those without CHD (12.93 +/- 7.23 and 6.25 +/- 5.66) and sub sample of subjects from both groups with duration of diabetes with 15 years or less were also analysed for comparison. Even after adjustment of duration the clustering of vascular complication in the subjects with CHD was striking. Presence of low HDL cholesterol was significant in both men and women diabetics with CHD (p < 0.01); while hypertension and poor metabolic control showed a strong positive correlation to CHD in women (p < 0.01 & p < 0.05). Multiple logistic analysis carried out separately in men and women showed that both low HDL cholesterol and elevated serum triglycerides showed strong association to CHD in both sexes; while in women in addition hypertension and insulin therapy also had a positive correlation to CHD (p < 0.01). Furthermore the influence of known duration of diabetes was not observed to be a significant contributor to the cardiovascular risk factors, since the above mentioned risk factors remained statistically significant in the subsample of patients with duration of diabetes less than 15 years.

Factors associated with isolation of pathogenic bacteria from sputum of patients with acute bronchospasm.

Patients with obstructive airways disease (asthma and chronic obstructive airways disease) with an acute exacerbation of symptoms were studied. Those requiring hospitalization were chosen to study the pattern of respiratory pathogens isolated on a supervised sputum culture. Certain variables were studied in a case control design to determine an association with culture positivity.

Betamethasone in tetanus patients: an evaluation of its effect on the mortality and morbidity.

The effect of betamethasone on the outcome in moderate to severe tetanus was studied in a randomised, double blind, placebo controlled study in 22 patients. The mortality rate was reduced by 36.1% with the addition of corticosteroids to the regime of treatment. Betamethasone did not alter the duration of intensive care in those requiring it, but reduced the need for tracheostomy and ventilation. The mean daily dose of diazepam required was not significantly different between the two groups and there was no increase in the incidence of infections in the betamethasone group.