Determinants of Poison-related Mortality in Tertiary Care Hospital, South India.

Aims and background: Acute poisoning is one of the most common emergencies in India and around the world. Understanding the factors associated with mortality can aid us in devising appropriate preventive strategies to curtail deaths due to poisoning. Purpose of this study is to find various factors that determine the mortality among acute poisoning cases admitted in a tertiary care center. Materials and methods: A retrospective hospital records-based study was conducted at Chengalpattu Medical College Hospital. The study included 2,123 cases of various poisoning cases admitted for a year from January to December 2022. Cases of bites, stings, drowning, and hanging were excluded. Information on sociodemographic profile, type of poison, time since ingestion and admission, and treatment outcome were collected using a structured pro forma. Results: The mean age of the study population was 29.90 ± 14.98 years. Poisoning was found to be predominantly among males (56.42%) and residents of rural areas (58%). Insecticide consumption (27.0%) was the most common modality, followed by oleander poisoning (20%), corrosive poison (17%), rat poison (15%), tablet poison (13%), and other poisons. The overall case fatality rate (CFR) was 5.2%, with the highest CFR of 12.25% with insecticide poisoning. In multivariate analysis, Glasgow coma scale (GCS) score at admission is the only parameter showing a statistically significant association with mortality (adjusted odds-ratio 0.271(0.2-0.38, p-value < 0.01). Conclusion: Acute poisoning primarily affects the young and economically productive population. In the south Indian population, pesticides are still the major contributor though corrosives are a major contributor among children. Mortality is still significant, and GCS status admission is the only predictor of mortality. How to cite this article: Krishnasamy N, Narmadhalakshmi R, Parameshwari P, Jayalakshmi R, Lokesh R, Jayanthi R, et al. Determinants of Poison-related Mortality in Tertiary Care Hospital, South India. Indian J Crit Care Med 2024;28(4):329-335.

More than 302 million people reached and over 2,200,000 trained in cardiopulmonary resuscitation worldwide: The 2021 ILCOR World Restart a Heart initiative.

Immediate bystander CPR after an out-of-hospital-cardiac arrest is likely to save hundreds of thousands of lives worldwide each year. International Liaison Committee on Resuscitation launched the World Restart a Heart initiative on October 16, 2018. In 2021 more than 2,200,000 persons were trained and at least 302,000,000 people were reached by WRAH global collaboration through print and digital media making it the highest-impact year since its inception. We strive for real success when CPR training and awareness become a year-round activity in all countries and all the citizens of the world realize that "Two Hands Can Save a Life!"

Perioperative factors associated with persistent postsurgical pain after hysterectomy, cesarean section, prostatectomy, and donor nephrectomy: a systematic review and meta-analysis.

ABSTRACT: Persistent postsurgical pain (PPSP) is a common and often disabling postoperative morbidity, but many questions remain about factors associated with PPSP. This systematic review and meta-analysis aimed to identify preoperative, intraoperative, and postoperative factors associated with PPSP after gynecological surgeries, namely, hysterectomy and cesarean section, and urological surgeries, namely, prostatectomy and donor nephrectomy. Overall, 18 gynecological surgery studies, 4 prostatectomy studies, and 2 donor nephrectomy studies met the review criteria, providing data that could be meta-analyzed. The average (±SD) PPSP occurrence after gynecological surgery was 20 ± 11%; factors associated with increased risk of PPSP included smoking, preoperative abdominal or pelvic pain, preoperative pain elsewhere in the body, longer duration of surgery, more intense acute postoperative pain, and surgical wound infection. The use of neuraxial anesthesia was associated with decreased PPSP risk. The average PPSP occurrence was 20 ± 9% after prostatectomy and 15 ± 2% after donor nephrectomy. For urological procedures, the existing data did not allow for identification of significant factors associated with PPSP, except for laparoscopic and hand-assisted laparoscopic approaches that were associated with lower incidence of PPSP for donor nephrectomy, and the use of neuraxial anesthesia which was associated with lower incidence of PPSP after prostatectomy. Persistent postsurgical pain after gynecological and urological surgeries is common. This systematic review identified important factors associated with cesarean section and hysterectomy that can help identify women who are at high risk of PPSP. More high-quality studies with consistent methodology are needed to understand the factors associated with PPSP risk, particularly for surgeries such as prostatectomy and nephrectomy.

Pharmacogenomics of Lithium Response in Bipolar Disorder.

Despite being the most widely studied mood stabilizer, researchers have not confirmed a mechanism for lithium's therapeutic efficacy in Bipolar Disorder (BD). Pharmacogenomic applications may be clinically useful in the future for identifying lithium-responsive patients and facilitating personalized treatment. Six genome-wide association studies (GWAS) reviewed here present evidence of genetic variations related to lithium responsivity and side effect expression. Variants were found on genes regulating the glutamate system, including GAD-like gene 1 (GADL1) and GRIA2 gene, a mutually-regulated target of lithium. In addition, single nucleotide polymorphisms (SNPs) discovered on SESTD1 may account for lithium's exceptional ability to permeate cell membranes and mediate autoimmune and renal effects. Studies also corroborated the importance of epigenetics and stress regulation on lithium response, finding variants on long, non-coding RNA genes and associations between response and genetic loading for psychiatric comorbidities. Overall, the precision medicine model of stratifying patients based on phenotype seems to derive genotypic support of a separate clinical subtype of lithium-responsive BD. Results have yet to be expounded upon and should therefore be interpreted with caution.

Olanzapine-Induced Hyponatremia Presenting with Seizure Requiring Intensive Care Unit Admission.

Rapid-onset hyponatremia is a rare, but potential, complication of olanzapine treatment. Hyponatremia, secondary to atypical antipsychotic use, has been reported in many case reports and is thought to be associated with a syndrome of inappropriate anti-diuretic hormone secretion (SIADH). Psychogenic polydipsia is a separate cause of hyponatremia, which is also seen in the psychiatric population, particularly in schizophrenia, and must be differentiated from SIADH. We report a case of sudden-onset hyponatremia resulting in seizure onset necessitating intensive care unit admission in a patient taking olanzapine during hospitalization in a psychiatric unit. Clinicians should be aware of the association between olanzapine and hyponatremia secondary to SIADH or psychogenic polydipsia. As in our case, the patient status may decline rapidly, resulting in seizure onset. Physicians should actively monitor patients taking antipsychotics for changes in serum sodium levels.

Delay of alternative antiviral therapy and poor outcomes of acyclovir-resistant herpes simplex virus infections in recipients of allogeneic stem cell transplant - a retrospective study.

Acyclovir is commonly used to prevent and treat herpes simplex virus (HSV) reactivation after hematopoietic cell transplant (HCT), and only few reports have been published on acyclovir-resistant HSV in HCT recipients. We reviewed the medical records of patients with a microbiologic diagnosis of acyclovir-resistant HSV by plaque reduction test who received an HCT from 2002 through 2014. A total of 4 028 HCTs were performed during the study period, and 18 of the recipients met the diagnostic criteria for acyclovir-resistant HSV. All cases had undergone allogeneic HCTs. Most patients were in the pre-engraftment period or on systemic corticosteroid therapy for graft-versus-host disease (GVHD). The median time between diagnosis and susceptibility testing was 15 days, and antiviral therapy was changed at a median of 27 days. Patients required prolonged therapy (~80 days), and many had serious complications including renal failure and hospitalization. In conclusion, acyclovir-resistant HSV infection is more likely during the period of profound deficit in T-cell-mediated immunity and is associated with significant morbidities. Higher doses of acyclovir prophylaxis might be needed for patients with history of HSV during pre-engraftment or GVHD treatment. In patients who do not respond or progress after 1 week of acyclovir therapy, testing for drug-resistant HSV, and early switch to an alternative antiviral should be considered.

Rats fed blended oils containing coconut oil with groundnut oil or olive oil showed an enhanced activity of hepatic antioxidant enzymes and a reduction in LDL oxidation.

The effects of feeding Wistar rats with blended and interesterified oils of coconut (CO):groundnut (GNO) or CO:olive (OLO) on liver antioxidant enzyme activities and susceptibility of LDL to oxidation were studied. The hepatic lipid peroxidation (LPO) levels in the rats fed CO:GNO blend and interesterified oils were increased by 31% and 21%, when compared to the rats given CO. The superoxide dismutase activity was increased by 31% and 28%, and catalase (CAT) activity was increased by 37% and 39%, respectively, in rats given blends and interesterified oils of CO:GNO, as compared to those given CO. The activities of glutathione peroxidase (GPx) were increased by 17% and 20% in rats given CO:GNO blend and interesterified oils. Glutathione transferase (GST) level was also found to be increased by 26% and 31% after feeding blended and interesterified oils of CO:GNO, compared to those given CO. The LDL oxidation, which was elevated by feeding GNO, was found to be reduced by 10% and 14%, respectively, in the groups fed blended and interesterified oils of CO:GNO. Similarly, CO:OLO blended oils enhanced SOD, CAT, GPx and GST activities by 34%, 43%, 27% and 23%, respectively, compared to the rats given CO-containing diets. The corresponding increases in theses antioxidant enzyme activities when CO:OLO interesterified oils were fed to rats were 38%, 50%, 28% and 26%, respectively, when compared to rats given CO-containing diets. There was a significant reduction in hepatic LPO as well as oxidation of LDL, when blended and interesterified oils of CO:OLO were fed to rats. The results demonstrated that blended and interesterified oils of CO with GNO or OLO enhance hepatic antioxidant enzymes, decreased lipid peroxidation in liver and reduced the susceptibility of LDL to oxidation.