A prospective clinical study of myocarditis in cases of acute ingestion of paraphenylene diamine (hair dye) poisoning in northern India.

BACKGROUND: Myocarditis is a unheard and unreported dangerous complication of hair dye ingestion which contains paraphenylene diamine. So a prospective study was planned to assess myocardial damage in regard to clinical profile and outcome with different treatment approaches in patients with oral ingestion of Hair dye. METHODS AND RESULTS: The material comprised of 1595 cases admitted in Medicine Department of Maharani Laxmi Bai Medical College, Jhansi, Uttar Pradesh-INDIA, from July 2004 to Jan 2011. Out of 1595 cases 1060 cases were of stone hair dye poisoning and 535 cases were of other branded hair dyes (powdered form containing less amount of Paraphenylene diamine). Diagnosis of myocarditis was made solely on the basis of the clinical signs/symptoms suggestive of myocardial damage, electrocardiography changes, elevated cardiac biomarkers and abnormalities on trans thoracic echocardiography. The cases were thoroughly studied for cardiac complications. Myocarditis was reported in 15% of total cases with mortality rate of 29%. Occurrence of myocarditis was directly related to amount of Hair dye ingested. In patients affected from myocarditis 9% develop life threatening Ventricular tachycardia/ventricular fibrillation. CONCLUSION: Hair dye (Paraphenylene di amine) is highly toxic. In cases who consumed more than 10 gram of Paraphenylene diamine, myocarditis is a dangerous complication. Proper management includes continuous cardiac monitoring to prevent sudden cardiac death.

Nephropathy in newly diagnosed type 2 diabetics with special stress on the role of hypertension.

OBJECTIVE: Nephropathy is a common complication in diabetes mellitus (DM), with significant morbidity and mortality. The aim of the present study is to study the incidence of nephropathy in newly diagnosed type 2 diabetics and to study the relationship of development of nephropathy with various risk factors associated with DM, like age, sex, blood pressure, blood sugar, body mass index (BMI). MATERIAL AND METHODS: We analysed 300 newly diagnosed type 2 diabetics (diagnosed within 6 months), between Jan 2008 to August 2009. Presence of urinary microalbuminuria in two samples in a period of six months was taken as criteria for detecting nephropathy. RESULTS: Incidence of nephropathy in newly diagnosed type 2 diabetics was 17.34% (52/300). It increased significantly with increase in age and was 30% in age group >60 years. It also has significant correlation with male sex and blood pressure with incidence of nephropathy being as high as 66.67% at BP> 160/100 mmHg. The incidence also increased with increase in BMI as well as HbA1C. Dyslipidemia also has significant effect. All results were statistically proven. Family history of DM has only little effect. CONCLUSION: Incidence of nephropathy in newly diagnosed type 2 diabetics is as high as 17.34%. Hypertension is the most important associated factor contributing to development of nephropathy in these patients. Poor glycemic control (high HbA1C), high BMI, dyslipidemia, age, male sex also play significant role. Family history of DM seems to have little effect.

Hair dye poisoning in Bundelkhand region (prospective analysis of hair dye poisoning cases presented in Department of Medicine, MLB Medical College, Jhansi).

AIMS OF STUDY: Hair dye (Paraphenylene di-amine, PPD) poisoning has high morbidity and mortality and its incidence has increased dramatically in the past 4 years. A prospective study was planned to assess the clinical profile and outcome with different treatment approaches. MATERIAL AND METHODS: The material comprised of 1020 cases admitted in Medicine Department of MLB Medical College, Jhansi, U.P. from July 2004 to March 2009. Out of 1020 cases 697 cases were of stone hair dye poisoning and 323 cases were of other branded hair dyes (powdered form containing less amount of Paraphenylene diamine). Diagnosis was made solely on the basis of the history given by cases/attendant and symptoms of neck swelling, black coloured urine and muscular pain. The cases were thoroughly studied for different complications (renal, hepatic and cardiac etc) and were treated accordingly. RESULTS: Out of 1020 cases studied, majority were females in the age group of 15-45 yrs (n=734) while the rest were males. A total of 244 (23.92%) cases expired during treatment. Neck swelling, respiratory distress and whole body muscular pain were most common symptoms at presentation, oliguria, chest pain, palpitation, presyncope/syncope, pain in abdomen, nausea with vomiting and dysphagia were other common symptoms. CONCLUSION: Paraphenylene diamine is highly toxic. Cases who consumed up to 10 gm of PPD usually survived if they presented to hospital within 4 hour of dye ingestion. Severe edema of face, neck and floor of mouth, renal failure and myocarditis were poor prognostic factors. No deaths occurred in cases of Branded Hair dye ingestion.