Acute and late complications of organophosphate poisoning.

OBJECTIVE: To describe the acute and late complications of organophosphate (OP) poisoning. STUDY DESIGN: Case series. PLACE AND DURATION OF STUDY: Medicine Department at Peoples Medical College Hospital, Nawabshah, from June 2008 to December 2009. METHODOLOGY: A total of 300 patients with organophosphate poisoning admitted to the Medical ICU were included. Baseline investigations included blood complete picture, urea, creatinine, arterial blood gas values, and serum cholinesterase levels. Data was retrieved from the files on a structured proforma. Studied variables included gender, mode of exposure, acute (occuring within 4 weeks) and delayed (occuring after 4 weeks onwards) complications RESULTS: There were 50 (16.66%) males and 250 (83.33%) females with ratio of 1:5. Two hundred and forty eight (82.6%) had ingested while 18 (6%) had inhaled the poison. Acute complications included fits in 50 (16.66) bradycardia in 30 (10%) and hyperglycemia in 15 (5%) patients. Delayed complications (after 4 weeks and later) included monoplegia and mild sensory loss of lower limbs in 4 (2.66) and paraplegia and weakness of upper limbs in 2 (0.66%) patients each. A total of 50 patients died due to different complications in acute period making a mortality rate of 16.66%. CONCLUSION: Frequency of acute organophosphate (OP) poisoning complications is much higher and related with high mortality and morbidity and where as late complications are less frequent and less life threatening.

Seasonal paradox in acute meningitis at Nawabshah.

OBJECTIVE: To assess the reasons for paradoxical increase in cases of meningitis in the summer of the year 2001. DESIGN: An observational study. PLACE AND DURATION OF STUDY: Medical Unit III, Peoples Medical College Hospital, Nawabshah, Pakistan, from 1st January, 2001 to 31st December, 2001. SUBJECTS AND METHODS: A total number of 229 cases of meningitis were admitted throughout the year with typical clinical features or CSF findings. Maximum number (179) was noted from April to July, which was alarming. The reason for this change was assessed in these cases. RESULTS: One hundred and seventy-nine cases of meningitis presented from 1st April to 31st July 2001. They were predominantly males n= 107 (59.7%) with age range of 15 to 64 years. Presenting symptoms were fever and headache in all and altered sensorium in 160 (89%) cases with positive signs of meningeal irritation in 175 (97.8%). Cerebrospinal fluid examination revealed altered biochemistry and neutrophil leucocytosis in all cases. Organism was identified in 139 (77.65%) cases on gram staining. Culture was done only in 61 (34.07%). Predisposing factors were smoking in 93 (52%) and diabetes in 17 (9.5%) cases. Five female patients were pregnant. CONCLUSION: Common organisms detected were gram positive diplococci (Streptococcus pneumoniae) in 83 (59.7%), gram negative diplococci (Nisseria meningitides) in 51 (36.7%) and Haemophilus influenzae in 5 (3.6%). As the frequency of isolates were approximately same as in other seasons, the increased in meningitis cases during summer was probably due to hot and dry weather causing low absolute humidity.