Kishore Gnana Sam

Poisoning severity score, APACHE II and GCS: effective clinical indices for estimating severity and predicting outcome of acute organophosphorus and carbamate poisoning

Self-poisoning with organophosphorus (OP) compounds is a major cause of morbidity and mortality across South Asian countries. To develop uniform and effective management guidelines, the severity of acute OP poisoning should be assessed through scientific methods and a clinical database should be maintained. A prospective descriptive survey was carried out to assess the utility of severity scales in predicting the outcome of 71 organophosphate (OP) and carbamate poisoning patients admitted during a one year period at the Kasturba Hospital, Manipal, India. The Glasgow coma scale (GCS) scores, acute physiology and chronic health evaluation II (APACHE II) scores, predicted mortality rate (PMR) and Poisoning severity score (PSS) were estimated within 24h of admission. Significant correlation (P<0.05) between PSS and GCS and APACHE II and PMR scores were observed with the PSS scores predicting mortality significantly (P< or =0.001). A total of 84.5% patients improved after treatment while 8.5% of the patients were discharged with severe morbidity. The mortality rate was 7.0%. Suicidal poisoning was observed to be the major cause (80.2%), while other reasons attributed were occupational (9.1%), accidental (6.6%), homicidal (1.6%) and unknown (2.5%) reasons. This study highlights the application of clinical indices like GCS, APACHE, PMR and severity scores in predicting mortality and may be considered for planning standard treatment guidelines.

Eemergence of Promising Therapies in Diabetes Mellitus

Diabetes mellitus (DM) results from defects in insulin secretion (type 1) or insulin resistance (type 2). Insulin is used to manage type 1 DM, and oral hypoglycemic agents are used to manage type 2 DM. These therapies are inconsistent in maintaining glycemic control and cause some severe adverse effects such as undue weight gain and hypoglycemia. New and appropriate therapies are needed to overcome these problems. Drugs that are in the pipeline include oral insulins for type 1 DM and incretin mimetics, incretin enhancers, gastric inhibitory peptides, amylin analogues, peroxisome proliferator‐activated receptor‐α/γ ligands, sodium‐dependent glucose transporter inhibitors, and fructose 1,6‐bisphosphatase inhibitors for type 2 DM. This article describes the mechanisms of action and relative advantages and disadvantages of the promising therapies

Effectiveness of hemodialysis in acute dapsone overdose-a case report.

The use of dapsone is increasing even though overdose is rarely reported and physicians must be aware of its toxicity and management. Mortality can occur due to methemoglobinemia and hemolytic anemia. Although activated charcoal and methylene blue are recommended, the use of hemodialysis is reported only in few studies. Literature on the kinetic profile indicates that 50% to 80% of dapsone is protein bound and indicates a possibility to dialyze the unbound form. This study describes a case of deliberate severe dapsone overdose with cyanosis, methemoglobinemia, and hemolytic anemia, which improved after repetitive hemodialysis.

Profile of acute mixed organophosphorus poisoning

Organophosphorus (OP) pesticide self-poisoning is a major clinical and public health problem across much of rural Asia and responsible for two thirds of suicidal deaths. However, clinical reports or evidence for the management of mixed poisoning are lacking. Patients are often treated based on the type of symptoms they exhibit, and there are no specific guidelines available to treat mixed poisoning. In this case series, we report 3 acute OP poisoning cases with mixed poisons such as organochlorine, fungicide, copper sulfate, and kerosene. All 3 patients were treated successfully, with a greater focus on OP poisoning with pralidoxime and atropine infusion along with standard decontamination procedures. Because patients developed complications due to the concomitant poisons ingested, they were later treated symptomatically, and in one case, D-penicillamine was administered as antidote for copper poisoning. Mixed poisoning especially with OP compounds makes the diagnosis difficult because the clinical symptoms of OP predominate, whereas damage produced by other pesticides is late to develop and often neglected. Common treatment procedures are focused mainly on the OP poisoning ignoring the complications of other concomitant pesticides ingested. Treating physicians should be prepared and consider the possibility of mixed poisoning prevalent in that region before initiating therapy.

Role of high-dose corticosteroid for the treatment of leptospirosis-induced pulmonary hemorrhage.

Leptospirosis is a zoonotic disease of worldwide distribution caused by spirochetes of the genus Leptospira. Leptospirosis is a common disease, highly prevalent in human populations but most often unidentified. The International Leptospirosis Society estimates that disease incidence ranges are 0.1 to 1.0 per 100 000 in temperate climates and 10 to 100 per 100 000 in humid tropics.1 In India, outbreaks have been increasingly reported since 1980s, especially from the states of Gujarat, Kerala, Karnataka, Maharashtra, Orissa, and Tamil Nadu.2 Outbreaks mostly occur as a result of heavy rainfall and consequent flooding, usually during monsoons.3 The clinical manifestation of leptospirosis varies from inapparent infection to fulminant fatal disease. Pulmonary complications for patients with leptospirosis are also relatively common, reported in 17% to 70% of patients in several large studies.4 Although these manifestations are usually mild, recent studies suggest that pulmonary involvement is frequently the most dramatic feature of leptospiral infection. Accordingly, severe pulmonary manifestations of leptospirosis are becoming more prevalent, with pulmonary hemorrhage being the most predominant cause of death in leptospirosis. The hemorrhagic potential of leptospirosis was first reported by Weil in 1886.5 The intense intra-alveolar hemorrhages seem to be unique for leptospirosis. Previous literature on diffuse alveolar hemorrhage heavily emphasizes the causal role of vasculitides.6 Use of steroids is rarely reported in leptospirosis-associated pulmonary hemorrhages. Here, we report a case of leptospirosis with pulmonary hemorrhage that was successfully treated with a high intravenous dose of methylprednisolone.

Evaluation of Web Sites for Quality and Contents of Asthma Patient Education

The patients and health care professionals worldwide depend largely on the internet for health care information due to its easy ubiquitous accessibility and economy, unlike the print media. The clinicians, health care professionals and asthma patients depend on the internet resources. The authentication of information on the web is an unmet demand. There is a growing need to provide quality information to the patients who desire education in the internet. As there is no system of validation of quality of information on internet, there can be a possibility of misleading or biased information on the internet. The present study aimed to evaluate the quality and content of information of websites providing patient education of asthma. Google search engine were used to identify 192 websites providing education on asthma, among which 42 were analyzed by Health on the Net Foundation Code of Conduct (HON code); Core Educational Concepts and Health Summit Working Group (HSWG) guidelines. On the basis of core educational concepts and HSWG criteria, websites were graded as excellent, good and average. Among the 42 websites, the HON code compliance was found to be very low (19%). A majority of the sites were compliant to basic HSWG criteria while lacking in few key elements. The HSWG scores were affected by development factors, and higher among those developed from public organizations of developed countries with non commercial interest. HSWG criteria and information on missing core educational concepts of HON code must be incorporated for an enhanced quality of information for asthma patient education.