The pattern of poisoning in khammam.

This study was undertaken to study the patterns of poisoning cases admitted at Mamata General Hospital Khammam, Andhra Pradesh from June 2005 to June 2010. The poisoning was common mode of suicide and one of the common causes of death in developing countries, particularly in agricultural workers. The emphasis was given on age, sex, socioeconomic status, etc. type and mode of poisoning. Organophosphate compounds were the most commonly 74.10% abused substance. The common motive of poisoning was suicidal 93.43% in both male 85.85% and female 14.14% with male to female ratio 6.07: 1%. Peak incidence was observed in the age group 21-30 years 50.59% and majority were from Hindu community 90.83% as compared to other community. The overall mortality of poisoning is 17.33%. Majority 366 (72.90%) were consumed the approximate amount of poison is 400-500 ml and maximum number of deaths 74 985.05%) are associated with highly toxic amount of 400-500ml of poison consumed. The study observed increasing trend of suicide by organophosphate compounds and rat poison ,whereas other poisons for committing suicide are less commonly used and here with–reflecting the pattern of poisoning in Khammam.

Trends of poisoning and gross stomach mucosal appearance in fatal poisoning cases: An autopsy study.

The study was of one year duration from 3rd December 2007 to 2nd December 2008 on fatal poisoning cases autopsied at Chigateri Government District hospital mortuary, attached to JJM Medical College, Davangere. The purpose was to know the trends of fatal poisoning cases in the region and also to know the gross stomach mucosal appearances in those cases. Material for the study included fatal poisoning cases autopsied. These poisoning cases included fatal animal bites also. All the data collected in detail was entered in the Proforma and later critically analyzed, tabulated, & compared with other various studies. Significant correlations were seen between- types of poison ingested & survival period, and between treatment intervention & survival period. It was an attempt to try to furnish poison suspected to the FSL based on case files and autopsy findings so as to hasten analysis and reporting.

prognostic value of the Glasgow coma scale, serum acetylcholinesterase and leukocyte levels in acute organophosphorus poisoning

Organophosphate poisoning [OP] is a serious clinical condition that may sometimes be fatal. The aim of this study was to determine whether the Glasgow coma scale [GCS], and serum acetylcholinesterase and leukocyte levels have prognostic value in acute OP poisoning. Retrospective review of records of patients admitted to the intensive care unit of Selcuk University, Meram Medical Faculty, Emergency Department, Konya, Turkey, between January 2006 and January 2009. We studied acutely OP-poisoned patients admitted within 24 hours after OP exposure. The mean age of the 25 patients was 37 years [range, 20-80 years]. Three [12%] of the 25 patients [male-female ratio, 12:13] died. The mean GCS values of the patients who died were significantly lower compared to those of the group that survived [4 vs 11.7, respectively P<.05]. While the mean serum acetylcholinesterase levels were lower in the patients who died, the difference in the mean serum acetylcholinesterase levels between the patients who died and the ones who survived was not statistically significant [3841 IU/L vs. 1768 IU/L, respectively]. Although serum cholinesterase values can be used in the quick diagnosis, their efficiency at predicting outcome in patients with OP poisoning has not been established. It has also been determined that serum leukocyte values have no prognostic value in OP poisoning, but GCS values have been found to be effective in predicting the outcome

Cardiotoxicity of acute organophosphate poisoning

To study the cardiotoxicity of acute organophosphate [OP], poisoning, this study was designed to evaluate 46patients who presented to the Benha poisoning control unit over a 14 months period from the 1st of March, 2007 to 30 April 2008, with acute OP poisoning and discus their associated cardiac complication and electrocadiographical [ECG] abnormalities. The serum level of cholinesterase [AChE] was significantly lower than the normal value. At the same time serum creatinine kinase [CK-MB] and cardiac trophonin I [CTnI] levels were significantly elevated at the time of admition indicating the presence some degree of cardiac injury. ECG changes confirmed the presence of cardiac injury. These was sinus tachycardia [34.78%] which the most common ECG abnormality, sinus bradycardia occurred in 9 patients [19.56%], hypertension developed in 6 patients [14.04%] and hypotension in 6 patients [13.04%]. OP induced impaired cardiac conductivity inform of prolongation of the QTc interval [32.61%] and prolonged PR interval [8.70%] and increased cardiac excitability in the form of extracystole [6.52%], ventricular tachycardia [2.17%] and atrial fibrillation [4.35%] and also induced myocardial cell injury manifested by elevated ST segment [15.22%]. Cardiac trophonin I [CTnI] level is indicated for diagnosis of cardiac injury due to OP poising when the patient is seen 3 days after intoxication. Most of cardiac complications associated with organophosphate occur during the first few hours after exposure. Sympathetic, parasymathatic over activity hypoxemia, acidosis and electrolyte derangements and a direct toxic effect of the OP on the myocardium are major predisposing factors for the development of these complications. The cardiac complications and ECG abnormalities all returned to normal before the patients were discharged. Initial complete ECG is recommended and should be obtained immediately in the Poison Control Unit in patients with acute OP or poisoning

[Epidemiologic study of Organophosphate and Organochlorate pesticides poisoning in hospitalized patients in Khorramabad Shohada Ashayer hospital from Mars to August 2006]

Poisoning is one of the most common medical emergencies. Every year many people refer to emergency wards due to poisoning and some of them are treated and some die because of severe complications. Most patients who refer to emergency wards are those who commit intentionally to suicide. This study is conducted to determine the prevalence of poisoning with pesticide [organophosphate and organochlorine] in persons referred to Shohada Ashaier hospital of Khorramabad in the first six months in 2006. Required information of poisoned people with poisoning pesticide [organophosphate and organochlorine] were collected using questionnaires which were distributed among the subjects. In this study 153 patients including 118 patients who poisoned with organophosphate and 35 patents with organochlorine were studied. Most of the patients [34.6%] aged between 21-71 years including 57.5% female and 42.5% male and their education was about under secondary school, 91.5% of them attempted to suicided. The total mortality rate was 12 that 7 of them died by toxifications with organochlorine and 5 cases by organophosphate, which in turn was due to their respiratory complications like ARDS and aspiration pneumonia. Findings indicate that due to high prevalence and mortality of poisoning with pesticides, this problem should be taken into consideration

The "intermediate syndrome" as critical sequelae of organophosphate poisoning: the first report of two cases in Thailand.

The authors report 2 cases of organophosphate poisoning which developed intermediate syndrome. The first case was a man who took an organophosphate insecticide, monocrotophos, and developed severe organophosphate poisoning. Respiratory support was needed. He was treated with atropine and 2-PAM. Weakness of neck muscles, proximal limb and respiratory muscle developed in the 3rd day after ingestion. By supportive treatment and careful monitoring, however, he recovered after 11 days of the poisoning. The second case was a lady who took dicrotophos. She developed severe organophosphate poisoning for which respiratory support was also needed High dose of atropine, but without 2-PAM, was administered. She developed bulbar palsy, proximal muscle and respiratory weakness 3 day after the ingestion. Ventilation support was needed for 13 days before weaning was successful. This report did not support an efficacy of pralidoxime (2-PAM) in alleviation of the intermediate syndrome, but aims to alert physicians to recognize the intermediate syndrome for which adequate respiratory care is the crucial key for its management.

Biochemical and clinical profile after organophosphorus poisoning--a placebo-controlled trial using pralidoxime.

BACKGROUND: Organophosphorus (OP) compounds are the most common suicidal poison in developing countries and mortality continues to be high. METHODS: A study was done to see butyryl cholinesterase (BuChE) profile after OP poisoning in pralidoxime (P2AM) and placebo treated cases. Highest recommended dose of P2AM was used to study the reactivation of cholinesterase. Clinical outcomes like, correlation of BuChE and severity of poisoning, mortality and complications like Type I and II paralysis, need for ventilation and ICU stay were also studied. RESULTS: Twenty one cases of moderate and severe poisoning with OP compounds were included in the study. Mean BuChE levels came up gradually over 6-7 days, some taking up to two weeks. There was no. difference between the treatment and placebo groups. BuChE levels did not correlate with severity of poisoning nor did it correlate with Type I or II paralysis, need for ventilation, ICU stay or mortality. CONCLUSIONS: Treatment with P2AM does not make any difference in BuChE reactivation or complications of moderate and severe OP poisoning. We have not been using P2AM for OP poisoning in our medical ICU with good patient outcomes.