Analysis of Clinical Profile, Cardiac Arrhythmias and Electrolyte Disturbances in Patients with Acute Yellow Oleander Poisoning

INTRODUCTION The yellow oleander (Thevetia Peruviana) is an ornamental tree, which is common throughout the tropics and subtropics. It contains cardiac glycosides that are toxic to cardiac muscle and the autonomic nervous system. Deliberate ingestion of oleander seeds has become a popular method of self-harm in India. Ingestion of oleander seeds results in a clinical picture similar to that of digoxin overdose. Severely poisoned patients may die in dc shock resistant ventricular fibrillation. Severe Hyperkalemia is a feature of acute oleander poisoning, which may further worsen toxicity and lead to serious Arrhythmias. So, it was decided to study the yellow oleander poisoning in our place regarding the clinical profile, ECG changes and Electrolytes changes which decides the mortality and modification of which would improve the prognosis in our patients. OBJECTIVES: To analyze the patients with acute yellow Oleander seed Poisoning with reference to- • Socio-demographic aspects, • Clinical Profile, • ECG Changes, • Electrolyte Status and • Outcome. MATERIALS & METHODS Setting: Poison Control, Training and research centre Govt.General Hospital & Madras Medical College, Chennai. Design of Study: Descriptive Study. Duration: Jan 2009 to June 2009. Data Collection: Clinical parameters, CBC, Blood sugars, Serum Urea, Creatinine, Serum Na+, Serum K+, LFT, ABG, ECG, and Gastric aspirate analysis. Brief Procedure: All patients admitted with consumption of yellow oleander seed or its extracts within 48 hours were studied. The study was carried out over a six-month-period beginning Jan 2009 to June 2009..A detailed history was obtained and patients were subjected to thorough clinical examination as well as ECG soon after admission. They were assessed on a hourly basis for the first 6 hours, 12 th hourly for next 72 hours on then daily basis until complete recovery. Results of biochemical investigations including serum electrolytes will be entered in a pre-designed proforma. Serial ECGs was collected. Inclusion criteria: Patients admitted to the toxicology ward within 48 hours of ingestion of poison. Exclusion criteria: 1. Patients with history of cardiovascular disease, 2. Patients on cardiac drugs, 3. Patients with chronic renal failure, 4. Patients on diuretics. CONCLUSION: 1. Oleander seed is still used as a suicidal agent. 2. Oleander plant is easily available as an ornamental plant in urban, semi-urban and rural areas. 3. Oleander seed poison is most prevalent in the 14-30 age groups. 4. Incidence is almost equal among the genders. 5. Death of patients was independent of the number of seeds they consumed. 6. ECG abnormalities were found in majority of the individuals. 7. Electrolyte disturbances (Changes in serum K+ levels) were found in significant proportion of the patients. 8. Prognosis was poor among those who presenting with Hypo-tension, Electrolyte disturbances specially those with Hyperkalemia, and complex Arrhythmias. 9. The arrhythmias produced by this poisoning may range from Sinus bradycardia to complete heart block

Perinatal outcome in meconium stained amniotic fluid

This prospective study was conducted to evaluate the perinatal outcome in meconium stained amniotic fluid. The study group consists of 300 patients in labour with meconium stained amniotic fluid. Among these patients, 50.7% had thick meconium stained liquor, 35% of the patients had thin meconium stained liquor and 14.3% of the patients had moderate meconium stained liquor. The control group consists of 100 patients in labour with clear liquor. • Meconium stained liquor was detected in the latent phase in 59% of the patients. Most of the patients (64.3%) in the study group were delivered within 1 hour of detection of meconium. • In the study group, 52.3% of patients had reactive NST and 47.6% had non reactive NST. Whereas in the control group, 86% of patients had reactive NST and only 14% had non – reactive NST. This shows that the incidence of non reassuring cardiotocography is significantly higher in women with meconium stained liquor in labour (47.6% vs 14%) P = 0.001. • In thin meconium group of patients, majority (74.2%) of the patients had reactive NST. Whereas in patients with thick meconium stained liquor, majority (60.5%) had non – reactive NST. This indicates a significant linear association between the thickness of meconium and abnormal fetal heart rate pattern during labour. • In the study group, almost half of the patients were delivered by cesarean section (52.7% vs 37% in the control group) P = 0.001. This higher rate of cesarean section in the meconium group is mainly contributed by patients in thick meconium group with non – reactive NST (36.7%). Fetal distress is the commonest indication for cesarean section in the study group (70.2% vs 18.9% in control group) p = 0.001. There was 31 cases of repeat LSCS in the study group and 14 cases of repeat LSCS in the control group. • In the meconium group with reactive NST 94.9% of babies had good mean Apgar score of ³ 7/10 at 1 and 5mins. With non – reactive NST, only 61.5% of babies had good mean Apgar score of ³ 7/10. In other words, 39.5% of babies had meand Apgar score of < 7/10. This shows that the incidence of low Apgar score at 1 and 5 minutes in meconium stained amniotic fluid was significantly higher when associated with fetal heart rate abnormalities. 39.5% vs 4.1%. • In the study group, 31.7% of the babies were admitted for NICU care. In patients with reactive NST only 13.4% of the babies were admitted, but in those patients with non – reactive NST 51.8% of the babies were admitted to NICU. (51.8% vs 13.4%); P = 0.001. Majority of the NICU admission is constituted by babies from thick meconium group with non – reactive NST (58.94%). • The commonest reason for NICU admission was mild respiratory distress (34.7%). The second most common reason was meconium aspiration syndrome (32.6%). The incidence of meconium aspiration syndrome in the study group was 10.3%. In the control group, only 5% of the babies were admitted. • The perinatal mortality in the study group was 3.3% as compared to no neonatal death in the control group. (3.3% Vs 0); P = 0.17. There were total of 10 neonatal deaths. 3 babies died in the thin meconium group, 1 baby died in moderate meconium group and 6 babies died in the thick meconium group. All neonatal deaths has occurred in those patients with non reactive NST (7% Vs0) P = 0.003, 95% CI = 7%, (2 – 12%). CONCLUSION : The incidence of non reassuring fetal heart rate pattern is significantly higher in women with meconium stained amniotic fluid in labour. There is a significant linear association between the thickness of meconium and abnormal fetal heart rate pattern during labour. • The perinatal outcome is good in patients with meconium stained amniotic fluid and reactive NST. • The cesarean section rate, low Apgar Score, neonatal admissions and perinatal mortality were significantly higher with meconium stained amniotic fluid and non reactive NST. So, meconium in the amniotic fluid is associated with obstetric hazard and significantly increased risk of adverse neonatal outcomes, only when it is associated with fetal heart rate abnormalities. The main clinical value of meconium stained amniotic fluid is to alert the obstetrician to look for further signs of fetal compromise

A STUDY ON MODERN TECHNIQUES USED IN IRRIGATION FOR FARMING IN COIMBATORE CITY

Water is most powerful natural resource it is mostly influences in health and wealth of the people and production of food. India economic backbone is agricultural. We are depending the water resources for development agriculture. Irrigation plays main role in the food production. The future expansion of food production will be increasing dependents upon sound irrigation and water management systems and now days the resources are most challenging because of environment changes. These days’ people prefer to use modern irrigational techniques because they are extremely efficient and effective. Modern irrigational techniques are also pivotal in increasing the crop yield. Also since these days farming is done with the help of fertilizers, crops need a certain amount of water to grow properly. Modern irrigational techniques are also cost effective, if done on a large scale. Also modern irrigational methods are important because of scarcity of water and increasing demand for food crops. For example: drip irrigation, if done properly can save up to 95% of water. According to me, modern irrigational techniques should be used and promoted because they save a lot of water

Compulsive Buying Behavior and Online Shopping Addiction of Women

The rise of e-commerce and online shopping platforms has revolutionized the way we shop and make purchases. While the convenience and accessibility of online shopping have been a boon for consumers, it has also led to the rise of compulsive buying behavior and online shopping addiction among women. The purpose of this paper is to explore the phenomenon of compulsive buying behavior and online shopping addiction among women and to understand the factors that contribute to this problem. This paper provides a comprehensive review of the literature on compulsive buying behavior and online shopping addiction using a purposeful sample of two hundred women who consider themselves to be addicted to online shopping. The findings from this paper can help shed light on the issue and inform future research and interventions aimed at addressing compulsive buying behavior and online shopping addiction among women

Return and Volatility Spillovers of Asian Pacific Stock Markets’ Energy Indices

The aim of the study was to investigate the presence of volatility among the Energy Indices of Asia Pacific Stock Markets. To test the volatility among the daily returns of Energy Indices of Asia Pacific Stock Markets, the study selected five sample Asian Pacific stock markets’ Energy Indices on the basis of availability of data. The findings of descriptive statistics and the ADF Test revealed, that the daily returns of the sample energy indices of Asian Pacific stock markets were not normally distributed and achieved stationarity at level difference, over the research period. Hence the data may be used for additional analysis. The data were then analysed, by using the GARCH (1,1) model to assess the considerable volatility of daily returns of sample energy indices and the study, which revealed that during the study period, all of the sample energy indices were volatile

Effect of COVID-19 Pandemic on NSE Nifty Energy Index

The research intends to assess the efficiency of NSE Energy Index-listed firms throughout the COVID-19 before and post pandemic phases, which run from 2019 to 2021. The primary goal of this article was to examine the price movement of corporations in the petroleum, gas, and electricity sectors by employing statistical methods such as descriptive statistics, ADF, and the GARCH (1,1) model, during the period of study. When comparing the post-COVID-19 pandemic era to the pre-COVID-19 pandemic period, certain firms experienced excessive volatility. The energy market's investor sentiment was significantly higher on the tail events, suggesting that anxious investors raced to put options and paid an exorbitant premium to shield them against unprecedented danger in the energy market

The Risk Factors and Outcome of Fungal Peritonitis in Continuous Ambulatory Peritoneal Dialysis Patients

Aim: To determine the risk factors and outcome of fungal peritonitis in continuous ambulatory peritoneal dialysis (CAPD) patients over a 7-year period. Patients and Methods: This retrospective study was conducted on 30 cases of fungal peritonitis in CAPD patients during a 7-year period (2000-2007). The diagnosis was based on elevated CAPD effluent count and isolation of fungi. Patients were evaluated for previous episode of bacterial peritonitis. Results: The incidence of fungal peritonitis was 16.2%. Age varied between 8 and 75 years, with a mean age of 57 years. Twenty-three were males (76.7%) and seven were females (23.3%). Seventeen patients (56.6%) had previous episodes of bacterial peritonitis that was treated with multiple antibiotics. The common fungus was Candida species (50%). CAPD catheter removal and initiation of antifungal therapy was done for all patients. Reinsertion was done for three (10%) patients. Mortality rate was 20%. Conclusion: Patients with previous bacterial peritonitis and antibiotic usage are at greater risk of developing fungal peritonitis