RESUMO
Background: worldwide, OPC are the most widely used insecticides in developing countries like Pakistan, where agriculture is the main occupation and easily available everywhere, therefore, the OPC poisoning is very common. WHO recently reports that pesticides poisoning occurs about 3 million/year with mortality > 3 lac/year and 99% belong to developing countries
Objective: to determine the frequency of various clinical and electro cardiac manifestation in OPC poisoning
Methodology: prospective observational study, conducted from Dec 2008 to April 2010 in Department of Medicine and Intensive Care Unit [ICU] at Liaquat University of Medical and Health Sciences, Jamshoro / Hyderabad
Results: out of 70 adult patients, 28[40%] were males and 42[60%] were females. The nature of OPC poisoning was suicidal in 58 [82.86%] and accidental/incidental in 12 [17.14%]. There were 43 [61.43%] farmers, 21 [30%] house-workers and 6 [8.57%] college students. There was a high ratio of insecticides [Melathion, Parathion, and Mite/rat House fly killer Carbamates] by ingestion/ inhalation route. The cardiac manifestations were Sinus Tachycardia in 20[28.6%], Non Cardiac Pulmonary Edema and Sinus Bradycardia 15[21.4%] each, Hypertension in 13[18.6%] and Hypotension in 07[10%]. Common ECG changes noted in our study were prolonged QTc - interval among 28[40%], prolonged P-R interval in 11[15.7%], atrial fibrillation, ventricular Tachycardia and extra systole were found as; 06 [8.6%], 05 [7.1%] and 05 [7.1%] respectively. Common neurological findings were flaccid paralysis in 28[40%] patients with respiratory muscle involvement in 10 cases, delirium in 11[17.5%], impairment of consciousness in 8[11.4%], and extrapyramidal features, fasciculation's, convulsions, and cranial nerve involvement were in 6 [8.6%], 5[7.1. %], 7[10%] and 5[7.1%] respectively
Conclusion: in routine hospital practice, the suicidal cases are very common due to acute OPC poisoning. Many cases are hospitalized with critical condition with predominant involvement of cardiac and neurological features. Early diagnosis with appropriate treatment with specific antidotes and ICU management can minimize the fatal consequences of OPC poisoning. It is further recommended that more studies are required to provide awareness regarding this important public health problem
RESUMO
Objective: to determine the frequency of H. pylori in cases of hepatic encephalopathy with liver cirrhosis
Study design and place: cross-sectional study to observe the role of H. pylori in HE patients of liver cirrhosis, conducted in Department of Medicine with collaboration to Intensive Care Unit [ICU] from January 2009 to December 2009 at Liquate University of Hospital Jamshoro/ Hyderabad
Results: out of 66 patients of HE, 44[66.7%] were male and 22[33.3%] were female, between 20 and 80 years of age. Based on Child-Pough's criteria, severity of hepatic decompensation Grading was as; in grade 1= 07 [10.6%], in grade 2= 21 [31.8%], in grade 3= 20 [30.3%] and in grade 4= 18 [27.3%]. Based on Child-Pough's criteria in class A= 01 [1.5%], in class B= 27 [40.9%] and in class C= 38 [57.6%]. Etiological factors for HE were as; HCV antibodies were positive in 32 [48.48%], HBsAg was positive among 18 [27.27%], HBsAg and HCV antibodies both were positive in 09 [13.64%], Alcoholics were 07 [10.6%] and Frequency of H. pylori was found in 47 [71.2%]
Conclusion: in our study we found that before and after 10 days H. pylori eradication therapy, there was no significant improvement in HE grade and other parameters. While the finding of high frequency of H. pylori in HE patients may be either co-incidence or co-relation that needs further vast studies