A study to assess the utility of poison severity score, pseudocholinesterase levels and Glasgow coma scale in predicting severity and clinical outcome of organophosphorus poisoning

Background: Suicides due to organophosphate self-poisoning is a major cause of concern world over. Organophosphate compounds (OP) possess a major cause of suicide in India.  There is a greater need for tools to predict severity of OP poisoning. We in this study try to assess the utility of the Glasgow coma scale (GCS), pseudocholinesterase levels and the poisoning severity score (PSS) in estimating severity and clinical prognosis of OP poisoning in patients of south India.Methods: A prospective study was conducted over 2 years in department of medicine, KIMS hospital and research centre, patients who were >18 years of age were included. OP poisoning was determined by either history of consumption or clinical features. Pseudocholinesterase levels at admission, PPS and GCS scores were assessed at admission and at 24 hours. Clinical, demographical, and certain laboratory investigation were recorded. Patients were followed till the patient stayed in intensive care unit.Results: In present study 100 patients were enrolled. Significant association was observed between GCS (p<0.001), PSS (p<0.001) and outcome of OP poisoning. Unexpectedly no significant association was observed with pseudocholinesterase level (p=0.118). A total of 83% patients were improved after treatment and mortality rate observed was 17%. Out of these 83% severe complications were observed in 14% of the patients.Conclusions: The findings of this study highlight the usefulness of GCS and PSS systems for predicting severity of OP poisoning. Identification of severity at an early stage followed by prompt treatment can prevent deaths. Our study did not find any association between pseudocholinesterase levels at admission and severity of OP poisoning

Incidence, determinants and outcomes of ventilator associated pneumonia in medical intensive care unit: a prospective cohort study from South Western India

Background: Ventilators are being increasingly used in developing countries as a result of which complications like ventilator associated pneumonia is also increasing. Present study is being undertaken to evaluate the impact of risk factors and their changing trends for Ventilator associated pneumonia.Methods: A prospective observational study was conducted in mechanically ventilated patients of medical intensive care unit from October 2013 to April 2015.Results: In present study 166 patients receiving mechanical ventilation in a medical ICU were observed. Incidence of VAP in present study is 43.5 for 1000 days of mechanical ventilation. The risk factors that were significant in the study are organ failure (p=0.001), emergency intubation (p=0.001), reintubation (p=0.023) and COPD (p=0.026). The common organisms responsible for VAP were Acinetobacter (30%), Klebsiella pneumoniae (27.1%) and Pseudomonas aeruginosa (20%). The mortality was higher in VAP group (31.3%) compared to the non VAP group (15.7%).Conclusions: There is high incidence of VAP in the developing countries. The risk factors that were found to be associated with VAP in the present study were the presence of COPD, reintubation, organ failure and emergency intubation. VAP is associated with significantly increased duration of hospital stay, morbidity and mortality

Quantitative analysis of heart type fatty acid binding protein in early detection of acute coronary syndrome

Background: Coronary heart disease is a major cause of mortality, morbidity and disability in developed countries. Even though coronary heart disease mortality rates worldwide have reduced over the past five decades, coronary heart disease is the major cause of death in one-third of people more than 35 years of age.Many risk factors and biomarkers have been studied in the past and research is on in detecting the acute coronary syndrome at the earliest so that reperfusion therapy can be undertaken as early as possible to save the life of patients. Heart-type fatty acid binding protein is a newer modality of investigation developed for the above purpose.Methods: Single centre cross-sectional observational study was conducted from 1 September 2017 to May 2019 with an aim to study novel cardiac biomarker h-FABP in patients with acute coronary syndrome and compare sensitivity and specificity of the same with that of troponin -T in the early detection of acute coronary events after fulfilling inclusion and exclusion criteria .The data of 80 patients were collected after getting informed consent. The clinical, demographic and investigations were performed as per the hospital protocol and such patients were recorded in the proforma. The additional test heart-type fatty acid binding protein is performed in the triage by collecting patient’s serum and by using point of care analysis machine. Statistical analysis was performed using SPSS version 20.0 and results were obtainedResults: Out of 80 patients selected males were 35 and female are 45. Chest pain was present in 58 people, dyspnoea was in 28, sweating in 40 people, 35 had anterior wall MI, 30 had Inferior wall MI and 15 had global hypokinesia. Median values of h-FABP values were 82 ng/dl, 53.2 ng/dl, 35.3 ng/dl at 0-6 hours, 6-12 hours, and 12-24 hours respectively after the onset of symptoms with a significant p< 0.001. There were major differences between median values between different time groups of symptoms onset. Median troponin T values were 0.061 ng/ml, 0.350 ng/ml, 1.56 ng/ml after 0-6 hours, 6-12 hours and 12-24 hours of onset of symptoms respectively. There was no correlation between h-FABP and troponin-T values.Conclusions: h-FABP rises early in coronary events in first 6 hrs of onset of symptoms of ACS serum levels of h-FABP decreases as time progresses in 24 hours. In comparison troponin-t levels continue to rise as time progresses. h-FABP serum levels can be used as novel marker for early detection of ACS

Post COVID-19 Guillain Barre syndrome with syndrome of inappropriate secretion of antidiuretic hormone

Guillain Barre syndrome (GBS) is a rare but potentially fatal immune mediated disorder of peripheral nerves and nerve roots usually triggered by infections characterized by ascending paralysis with or without sensory symptoms, hyporeflexia to areflexia. Usually preceded by gastrointestinal or respiratory infection. Post COVID-19 neurological manifestation include GBS, transverse myelitis etc., occur at varying incidence rates at various places. Here we report a 42-year-old lady who had COVID-19 recovered presented with quadriparesis with absent deep tendon reflexes with electro-diagnostically proven AMSAN variety of GBS treated successfully with IVIg. Patient was having hyponatremia which was diagnosed to be due to SIADH and was successfully treated with fluid restriction and tolvaptan. This case is being reported due to combination of COVID-19, COVID vaccination shortly before GBS and hyponatremia due to syndrome of inappropriate secretion of antidiuretic hormone (SIADH) which is quite rare combination