Reasons for under-reporting of paraquat poisoning in India

BACKGROUND Paraquat is an inexpensive herbicide used in agriculture because it is easily available and the cost of labour for manual clearance of weeds is prohibitive. Paraquat is toxic to human beings and is also used for committing suicide. We studied the reasons for under-reporting of paraquat poisoning including those related to the training of doctors. METHODS In this mixed-methods study, we describe a series of patients with paraquat poisoning. We recorded their demographic data, clinical features, treatment and outcome with an intention to explore the reason for an initial misdiagnosis. We also explored whether deficiencies in curricula contributed to the misdiagnosis. RESULTS The patients of paraquat poisoning (n=28) were mostly young illiterate men driven by impulsive behaviour rather than chronic depression. Paraquat was consumed by patients from non-agricultural background as well, implying easy access to the poison. Many patients could not name the agent and so initial treatment was directed at organophosphorus poisoning. The diagnostic signs included paraquat tongue, renal failure and jaundice. Most of the casualty medical officers and residents were unfamiliar with the symptoms and signs of paraquat poisoning as was evident by their answers to the questionnaire. Knowledge of medical students about paraquat poisoning was not assessed in the theory examinations and viva. CONCLUSION Factors contributing to the limitation in establishing the diagnosis are illiteracy and ignorance of the patients, lack of specific signs and lack of training of medical officers in treating patients with paraquat poisoning.

A cross sectional study on health status and prevalence of risk factors of non-communicable diseases among auto rickshaw drivers of Hyderabad, Telangana

Background: Auto rickshaws form 10-20% of daily motorized urban transport and ensure connectivity and easy access throughout congested Indian cities. Harmful lifestyles practiced by auto rickshaw drivers like irregularity of meals, bad posture while driving, sedentary lifestyle predisposes them to many gastrointestinal, respiratory, musculoskeletal, cardiovascular diseases. This study was taken to assess the risk factors of non-communicable diseases among of auto rickshaw drivers. Objectives of the study were to estimate the proportion of various non-communicable diseases among study population and to assess various risk factors for non- communicable diseases among study population.Methods: A cross sectional study was carried out among 100 auto rickshaw drivers, aged above 20 years commuting at bus terminus and railway station in Hyderabad, Telangana using a predesigned questionnaire from May to July 2018.Results: The mean age of the study population was found to be 41.58±10.9 years. Around 14% of study subjects had history of diabetes mellitus and 15% hypertension. About 69% were overweight or obese, 41% had refractive errors and majority had musculoskeletal problems. The mean duration of physical activity was found to be 35±7 minutes/day.Conclusions: The prevalence of cardio vascular disease risk factors i.e. tobacco smoking, sedentary lifestyle, obesity was found to be quite high among auto rickshaw drivers. Early precautionary measures, regular medical check-up and prompt interventions are necessary for managing risk factors

Solitary periosteal osteoma of the mandible. A case report

Osteoma of the jaw bones is a rare entity with very few cases reported in the literature. Osteomas are benign, slow-growing osteogenic tumours of the bone commonly encountered in the craniofacial skeleton and characterised by the proliferation of compact or cancellous bone. They can be central, peripheral or extra-skeletal in their location. In the facial region, periosteal osteomas occur more frequently in the paranasal sinuses, but solitary periosteal osteomas of the jaw bones are quite rare. The mandible is more commonly affected than the maxilla, with the sites of predilection being the lingual aspect of the body, the angle and the inferior border. We report a case of a solitary periosteal osteoma on the buccal aspect of the mandible in a 42-year-old woman

Cholera outbreak secondary to contaminated pipe water in an urban area, West Bengal, India, 2006.

Outbreaks of cholera are common in West Bengal. In April 2006, Garulia municipality reported a cluster of diarrhea cases. We investigated this cluster to identify the etiological agent, source of transmission and propose control measures. We defined a case of diarrhea as occurrence of >3 loose/watery stools a day among the residents of Garulia since April 2006. We searched for cases of diarrhea in health care facilities and health camp. We conducted a gender- and age-matched case–control study to identify risk factors. We inspected the sanitation and water supply system. We collected rectal swabs from diarrhea patients and water specimens from the affected areas for laboratory investigation. Two hundred and ninetyeight cases of diarrhea were reported to various health care facilities (attack rate: 3.5/1000, no deaths). The attack rate was highest among children (6.4/1000). Vibrio cholerae El Tor O1 Inaba was isolated from two of 7 rectal swabs. The outbreak started on 10 April 2006, peaked on 26 April and lasted till 6 May. Cases clustered in an area distal to leaking water pipelines. Drinking municipal water exclusively was significantly associated with the illness (OR 13, 95% CI=6.5–27). Eight of the 12 water specimens from the affected area had fecal contamination and poor chlorine content. This outbreak was due to a contaminated municipal piped water supply and V. cholera 01 Inaba was possibly the causative organism.

Empyema thoracis due to actinomyces odontolyticus.

Actinomyces odontolyticus has been reported as an opportunistic pathogen causing systemic infections. A case of empyema thoracis due to this organism in a 68-year-old male is reported here. The patient did not have any underlying disease or immunosuppression. The organism was isolated from his oral flora also. Eight cases of thoracopulmonary infections due to A. odontolyticus have been reported from the western countries, but none from India.

The co-occurrence of tobacco & alcohol in general population of metropolis Delhi.

BACKGROUND & OBJECTIVES: The association between tobacco and alcohol use behaviours has not been explored in India. This study reports on the co-occurrence of tobacco and alcohol use in a representative general population in metropolis Delhi at two points of time a year apart. METHODS: Matched data on 10,312 individuals from 2937 households above the age of 10 yr were available for survey I and survey II. Among them 5414 were males and 4898 females. The subjects were interviewed by non clinical staff using a structured proforma based on DSM III R criteria on the use of tobacco, alcohol, cannabis and opioids. RESULTS: Among women, use of only tobacco was reported. Among males, the prevalence of use of 'only tobacco', 'only alcohol' and concurrent smoking and drinking was 18.1, 3.3 and 9.6 per cent respectively. Concurrent use was higher in the age group 31-40 yr and dependence higher in the 41-50 yr age group. Both at surveys I and II current smokers had higher percentage of alcohol drinkers compared to tobacco abstainers; dependent smokers had higher percentage of dependent drinkers. The use of alcohol at survey II was higher among tobacco smokers compared to tobacco abstainers identified at survey I (OR = 5.77, 95% CI 4.3-7.7). INTERPRETATION & CONCLUSION: Our results demonstrate a positive correlation between smoking and drinking. The findings lend support to existing evidence suggesting associations between tobacco and alcohol use. Smoking proved to be a powerful predictor of alcohol use. It is suggested that professionals who treat alcoholism should pursue the cessation of smoking among their patients.

Incidence estimates of substance use disorders in a cohort from Delhi, India.

BACKGROUND & OBJECTIVES: There are no reports of incidence studies in the Indian setting on substance use disorders in the general population. This survey-resurvey carried out in metropolis Delhi estimated the incidence rates of substance use disorders. METHODS: A cross-sectional survey was carried out at two points of time with an interval of one year in a representative sample from the general population of metropolis, Delhi. The instrument was precoded, structured and based on DSM III-R operationalised criteria for use of tobacco, alcohol, cannabis and opioids (past one month). Matched data for two points of time were available for 5414 males and 4898 females. RESULTS: In the total cohort, the annual incidence rates (per 100 persons) among males for any drug use, alcohol, tobacco, cannabis and opioids were 5.9, 4.2, 4.9, 0.02 and 0.04 respectively. Among females, incidence of any drug use was 1.2/100 persons. INTERPRETATION & CONCLUSION: Results showed that males have higher incidence for both not-dependent and dependent use for all the drug categories. Females had a higher incidence of dependent tobacco use.

A rapid assessment study on prevalence of substance abuse disorders in metropolis Delhi.

BACKGROUND & OBJECTIVES: No studies in India have attempted to identify in the general population a 'dependent drug user' based on clinically used diagnostic criteria. This two point survey estimated the prevalence of substance use disorders and the change in the trends of drug use after a period of one year in metropolis Delhi. METHODS: A total of 72 colonies in five types of housing clusters were surveyed. The head of the household (HOH) was interviewed only for collecting information about family members (above 10 yr) on an instrument based on the DSM III R operationalised criteria. Trained non medical interviewers administered the precoded instrument to 6004 and 5599 HOH in the first and second surveys respectively. RESULTS: In the first survey, the prevalence of tobacco, alcohol, cannabis and opioids use among males was 27.6, 12.6, 0.3 and 0.4 per cent respectively. The rates were highest in resettlement clusters followed by urban villages, unauthorized, regularized and in 'others' clusters. The use rates remained unchanged during the re-survey. Dependent use (any drug) increased in the resettlement clusters only during the re-survey. INTERPRETATION & CONCLUSION: The results highlight that it is the legal drugs viz., tobacco and alcohol that could pose higher health and social consequences, both short and long term. The situation of illicit drug use (heroin) was higher in the resettlement clusters and urban villages. Need based programmes have to be evolved and executed to keep the drug dependent population stable. The rapid survey technique can be useful in developing countries like India, where resource crunch for survey research is acute. This technique is less costly, quicker to perform and can supplant traditional self-report methodologies.

Paralytic poliomyelitis in a rural area of north India.

BACKGROUND: Paralysis due to poliomyelitis is common in rural areas. The extent of paralysis, type and place of treatment and effect of local treatment on children with poliomyelitis was assessed in a house-to-house survey conducted between 1990 and 1991 in a rural area of north India. METHODS: Trained field workers conducted a house-to-house survey in 9 villages of Haryana with a total population of 22,883. All cases of deformity and muscular weakness suspected to be due to poliomyelitis were examined and details regarding immunization, diagnosis, treatment and follow up were recorded. The late consequences of neglect as well as inappropriate medical advice were also assessed by physical examination and direct questioning of the parents. RESULTS: Thirty-seven cases of paralytic poliomyelitis were identified indicating a prevalence rate of 1.6 per 1000 population. Of these, 97% were paralysed before they were 2 years old and 60% had a history of intramuscular injections preceding paralysis. Only 14% of them had received either partial or complete immunization. The majority of families preferred to take treatment from traditional healers or in city hospitals but not from primary health centres. CONCLUSION: Despite the national immunization programme, paralytic poliomyelitis continues to be a significant problem in the villages surveyed. Primary health centres are an unreliable source of epidemiological data for paralytic poliomyelitis as villagers do not prefer to visit them for treatment of the disease. Injections given for treatment of fevers in rural areas may play a role in precipitating paralytic poliomyelitis. These findings highlight the urgency of a broad-based primary health care approach at primary health centres. Traditional healers and private practitioners should be trained to provide physiotherapy to children with polio and educated about the importance of not giving injections to children with minor fevers.

Developmental study of thermotolerance and the heat shock response in Lucilia cuprina (Weidemann).

The ability to withstand thermal stress in a laboratory population of the blowfly Lucilia cuprina (measured as per cent adult survival following varying periods of exposure to elevated temperature up to a maximum of 48°C) was in the order pupa > larva > adult. Pre-exposure to a mild heat shock (37°C) induced tolerance to temperatures which were otherwise lethal. An analysis of heat shock-induced protein synthesis during development at similar elevated temperatures presented patterns corresponding to the above observations on thermotolerance. The induced level of synthesis of major heat shock proteins (viz., 79, 69, 28, 20 and 19 kDa) were greater in larval tissues than in most of the adult tissues except gonads. The response varied between young (2 days) and old (30 days) adults in a tissue-specific manner. In general, heat shock protein 69 kDa was most abundant in all the tissues studied. Control as well as heat shocked Malpighian tubules of adults uniquely showed two major [35S]methionine labelled bands corresponding to approximately 62 and 64 kDa. Immunoblots showed the 62 kDa protein to cross react with an antibody against Helioihis HSP60. Although the synthesis of the 62 kDa polypeptide was prominent only in Malpighian tubules of adult blowflies, nearly equal levels of this HSP60 family polypeptide were present in all tissues (control as well heat shocked) except the larval salivary glands.

A rapid survey on substance abuse disorders in the urban slums of New Delhi.

The results are presented of a rapid survey screening method of general population for identifying dependent and non dependent drug abusers, especially in vulnerable groups such as slum dwellers. The results showed that with the help of instrument with modified DSM III and interviewing only the heads of the households it was possible to get reliable estimates of dependence disorder in the community. This method can be of assistance to health planners for a quick assessment of the magnitude of the problem leading to better allocation of funds and developing services for the affected population. The method is an improvement on key informant technique and a full fledged survey.