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Introduction: Snakebites are a significant cause of morbidity and mortality in India despite availability of anti-snake venom and the absence of a large number of highly venomous snakes. This may be attributed to treatment seeking behaviour of the population. The study aims to find out common clinical features, outcome, and delay in arrival time to the hospital in snakebite cases. Materials and Methods: This is a cross-sectional retrospective record-based study among the patients presented with a history of snakebites to the Basaveshwara Medical College Hospital and Research Centre, Chitradurga, conducted from 1 January 2019 to 31 January 2021. Results: Out of the 96 patients, the majority of snakebite victims were male and of an age group of 21-30 years. The most common site for snakebite was the lower limb, and about 57.2% of patients had visible fang marks. Among snake species identified, the most common was krait bites, followed by cobra bites. Neurotoxic envenomation manifestation and severe presentation were found in almost half (53.1%) of the cases. Almost half of the patients took 1-4 hours to arrive at the health facility. Surprisingly, only 35% cases arrived to the health care facility within an hour of snakebite. Most of the patients (82%) recovered with the treatment with very minimal fatality/mortality. Conclusion and Recommendations: Although half of the patients presented with severe forms, only 35% of the patients arrived within an hour to the health care facility. This indicates the need for an information dissemination system to avoid severe disease as well as to prevent mortality.
RESUMO
Background Levobupivacaine toxicity reports are rare, and when they do occur, toxic symptoms are frequently treatable with minimal morbidity and mortality. However, levobupivacaine has not entirely replaced bupivacaine in clinical practice. Moreover, the experience of intrathecal anesthesia with levobupivacaine is not well documented. Hence, the purpose of this study is to assess the quality and duration of sensory and motor blockade of levobupivacaine and its side effects, if any, compared to intrathecal bupivacaine during infraumbilical surgeries. Methods After approval by the Institutional Ethical Committee of Kurunji Venkatramana Gowda (KVG) Medical College and Hospital, Sullia, 90 patients aged between 18 and 65 years, of either sex, who were scheduled for elective abdominoperineal, urological, or lower limb surgeries under intrathecal anesthesia were enrolled in this prospective study from January 2013 to June 2014. The selected patients were randomly assigned to three groups of 30 each: group HB (3 mL of 0.5% hyperbaric bupivacaine), group IB (3 mL of 0.5% isobaric bupivacaine), and group IL (3 mL of 0.5% isobaric levobupivacaine). Motor blockade was assessed using the modified Bromage scale. Intergroup comparison was done using Tukey's post hoc test. The incidence of adverse effects was analyzed using a chi-squared test. Significance was defined as P<0.05. Results In our study, the mean age of patients in the three groups was comparable (P>0.05), i.e., group IB was 39.23±11.78 years, group HB was 43.63±11.33 years, and group IL was 39.8±12.07 years. The time of onset of sensory block was 6.57±1.794 minutes in group IB, 2.30±1.343 minutes in group HB, and 4.57±1.960 minutes in group IL, and this variation was statistically highly significant (P<0.001). A total of 15 patients suffered hypotension intraoperatively, of which eight belonged to group HB, four to group IB, and the rest to group IL. Intraoperative or postoperative nausea/vomiting was seen in five patients in group IB, two patients in group HB, and one patient in group IL. In the postoperative period, the mean heart rate (HR) was 77.47±4.88/minute in group IB, 68.78±7.88/minute in group HB, and 72.15±8.83/minute in group IL. The data was statistically highly significant (P<0.001). Conclusion Our study revealed that 15 mg of isobaric levobupivacaine (3 mL of 0.5%), the new racemic isomer of bupivacaine, was intermediate in its anesthetic properties when compared to isobaric bupivacaine and hyperbaric bupivacaine. The onset of sensory and motor blockade is slower than hyperbaric bupivacaine but faster than isobaric bupivacaine with a higher level of maximum sensory block.
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Background There have been reports published in the Indian setting that describe demographics, clinical characteristics, hospital course, morbidity, and death in coronavirus disease 2019 (COVID-19) patients; however, they are based on small numbers of cases. The current analysis of patients with known outcomes allowed us to gain a better understanding of the disease process and progression in COVID-19 patients, as well as correlate the factors that influence the outcome. Methods This was a record-based, retrospective observational study of patients admitted to a COVID-19 hospital (All India Institute of Medical Sciences (AIIMS), Raipur, India). Between June 1 and August 31, 2021, we gathered medical records of all hospitalized patients having a laboratory-confirmed COVID-19 diagnosis and a known outcome (discharged or died). The extracted data included basic demographics, signs and symptoms, duration of hospitalization, laboratory parameters, and outcomes. Categorical variables were analyzed using either the chisquare test or Fisher's exact test. The level of significance was set at p<0.05. Results The mean age of the patients was 53.77±15.85 years. Of the patients, 84.2% have moderate to severe disease, and 15.8% of the patients have mild disease. Furthermore, 26.3% of the subjects were deceased, while 73.7% were discharged. The laboratory parameters that were significantly (p<0.05) raised among the dead compared to discharged patients included serum total bilirubin (mg/dL), serum direct bilirubin (mg/dL), serum indirect bilirubin (mg/dL), serum urea (mg/dL), serum uric acid (mg/dL), hematocrit (%), total leukocyte counts (/mm3), neutrophils (%), serum sodium (Na) (mEq/L), serum chloride (Cl) (mEq/L), and phosphate (mg/L). Conclusion Clinical and laboratory features reflect disease pathophysiology and hence assist doctors in determining the severity of medical sickness. They also help in the creation of clinical care management algorithms that may improve patient outcomes.
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Background Most poisoning events among children are preventable and the major reason is lack of supervision by adults, including poor knowledge and attitude toward storage of such items. So, the prevention policy on children's poisoning shall take into account the age group, gender, socioeconomic status, residence, and other aspects such as the knowledge and attitude of adults. The present study was conducted to describe the profile of poisoning in the paediatric population in a tertiary care teaching hospital. Methods Our observational study was retrospective and was conducted at Basaveshwara Medical College and Hospital (BMCH), Chitradurga, Karnataka, under the Department of Forensic Medicine for a duration of three months (February 2021 to April 2021). Institutional ethical approval was obtained prior to the start of the study. As our study participants were paediatric patients (0-17 years) with acute poisoning (excluding homeopathic drug ingestion), a total of 81 paediatric patients' case sheets were finally reviewed and analysed. The data of paediatric poisoning cases were collected in a predesigned study proforma and included details about children's age (in years), gender (male, female), residence (rural, urban), outcome (death, discharge), nature of poisoning (accidental, suicidal), and toxic agents in poisoning. The collected data were entered and analysed in the Microsoft Excel spreadsheet (Microsoft Corporation, Redmond, WA). Results The incidence of acute poisoning among the paediatric population in our teaching hospital was 1.4%. The most common age group with acute poisoning was 13-17 years (30.9%). The prevalence of acute poisoning was higher in male children (56.8%) when compared to female children (43.2%). Around three-fourths of paediatric cases (71.6%) with acute poisoning were having a rural residence. The overall mortality rate among children due to acute poisoning was 9.9%. The most common toxic agents involved in acute poisoning among children were organophosphate compounds (35.8%), followed by organochlorine compounds (30.9%) and pyrethrum compounds (11.1%). Conclusion From this study, we concluded that acute poisoning among children is mainly accidental, and the most common toxic agent responsible for the poisoning is pesticide or insecticide. Most poisoning events among children are preventable, and the major reason is a lack of supervision by adults, including poor knowledge and attitude toward storage of such items.
