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Introduction: Organophosphate compounds are often usedfor homicidal and suicidal purposes. It accounts for about80% of pesticide related hospital admissions. Study aimed toassess the severity of OP poisoning by POP scale, PSS andGCS and to compare POP scale, PSS and GCS in predictingthe treatment outcome in OP poisoning.Material and Methods: 100 patients of OP compoundpoisoning were included in the study. POP score, PSS andGCS were assessed at the time of presentation and weregrouped based on the severity. These scores were individuallyevaluated in predicting the ventilator requirement andmortality in OP compound poisoning and the scores werecompared with each other, as to asses which score was betterin predicting the severity of OP poisoning.Results: Ventilator requirement and mortality was found tobe in 43% and 16% of patients respectively. Intubation ratesand mortality rates were higher in patients with severe gradesof POP score, PSS and GCS with a significant p value (0.00),than in patients with mild to moderate grades. All three scorescorrelated well in predicting the requirement of ventilatorysupport and mortality in OP compound poisoning cases.Conclusion- The three scoring systems are simple andeffective tool that can be assessed based on the clinicalexamination. For a resource limited country, like India, any ofthe three scoring systems can be applied at the primary caresetting level which helps in making timely decision regardingneed for ventilatory support and timely shifting of patient tothe ICU care setting.
RESUMO
A case of diffuse nesidioblastosis in an adult patient is reported in this study. A 24-year-old female with no known comorbidities presented with multiple episodes of documented recurrent hypoglycaemia and Hypoglycaemia induced seizures both in fasting and postprandial state. Her blood investigations revealed low plasma glucose levels, high insulin and C-peptide levels with positive 72-hour fast test. Her transabdominal USG and CECT abdomen did not reveal any abnormality, 68Ga DOTANOC PET CT done showed ill-defined diffuse somatostatin receptor expression in the pancreatic head and tail suggestive of nesidioblastosis. As patient was not willing for surgical treatment, hence started on medical treatment with oral nifedipine. Nesidioblastosis is very rare in adults. It is an important differential diagnosis in adults with hyperinsulinemic hypoglycemia although the incidence is very rare in adults. PET SCAN was used to non-invasively diagnose nesidioblastosis in this case. Surgery being the preferred choice of treatment in nesidioblastosis, there is limited data on medical line of management in nesidioblastosis.