Risk assessment in poisoning with special reference to odollam and organophosphorous compounds

Background: Poisoning with organophosphorous compounds, odollam and other substances are common. Affected persons present with a wide variety of clinical features. Prognostic indicators of high mortality are important for management and to decide on intensive care unit admission.Methods: Admissions due to poisonings from April 2015 to March 2016 were assessed. The clinical features, electrocardiographic changes and laboratory investigations of 915 patients were obtained and statistically analysed.Results: The most commonly ingested poisons were odollam (26%) and organophosphorous compounds (22%). The overall mortality was 22%. Mortality was highest in organophosphorus compounds (38%) and odollam (33%) compared to other causes. Hyperkalemia, low systolic blood pressure, consumption of poison in powder or paste form, delayed presentation, bradycardia and extensive chest signs correlated with mortality in odollam and organophosphorous compound poisoning.Conclusions: Poisoning with odollam or organophosphorous compounds is an increasingly common life threatening condition. Markers of mortality identified in this study were incorporated into a simple scale for assessment of risk, namely the PoPPER scale: potassium level >5.5 mE/L, systolic blood pressure <90 mmHg, paste/powder form of poison ingestion, extremely late presentation, rate of QRS <40/min or impending respiratory paralysis.

The global burden of adolescent and young adult cancer in 2019 : a systematic analysis for the Global Burden of Disease Study 2019

Background In estimating the global burden of cancer, adolescents and young adults with cancer are often overlooked, despite being a distinct subgroup with unique epidemiology, clinical care needs, and societal impact. Comprehensive estimates of the global cancer burden in adolescents and young adults (aged 15-39 years) are lacking. To address this gap, we analysed results from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019, with a focus on the outcome of disability-adjusted life-years (DALYs), to inform global cancer control measures in adolescents and young adults. Methods Using the GBD 2019 methodology, international mortality data were collected from vital registration systems, verbal autopsies, and population-based cancer registry inputs modelled with mortality-to-incidence ratios (MIRs). Incidence was computed with mortality estimates and corresponding MIRs. Prevalence estimates were calculated using modelled survival and multiplied by disability weights to obtain years lived with disability (YLDs). Years of life lost (YLLs) were calculated as age-specific cancer deaths multiplied by the standard life expectancy at the age of death. The main outcome was DALYs (the sum of YLLs and YLDs). Estimates were presented globally and by Socio-demographic Index (SDI) quintiles (countries ranked and divided into five equal SDI groups), and all estimates were presented with corresponding 95% uncertainty intervals (UIs). For this analysis, we used the age range of 15-39 years to define adolescents and young adults. Findings There were 1.19 million (95% UI 1.11-1.28) incident cancer cases and 396 000 (370 000-425 000) deaths due to cancer among people aged 15-39 years worldwide in 2019. The highest age-standardised incidence rates occurred in high SDI (59.6 [54.5-65.7] per 100 000 person-years) and high-middle SDI countries (53.2 [48.8-57.9] per 100 000 person-years), while the highest age-standardised mortality rates were in low-middle SDI (14.2 [12.9-15.6] per 100 000 person-years) and middle SDI (13.6 [12.6-14.8] per 100 000 person-years) countries. In 2019, adolescent and young adult cancers contributed 23.5 million (21.9-25.2) DALYs to the global burden of disease, of which 2.7% (1.9-3.6) came from YLDs and 97.3% (96.4-98.1) from YLLs. Cancer was the fourth leading cause of death and tenth leading cause of DALYs in adolescents and young adults globally. Interpretation Adolescent and young adult cancers contributed substantially to the overall adolescent and young adult disease burden globally in 2019. These results provide new insights into the distribution and magnitude of the adolescent and young adult cancer burden around the world. With notable differences observed across SDI settings, these estimates can inform global and country-level cancer control efforts. Copyright (C) 2021 The Author(s). Published by Elsevier Ltd.Peer reviewe

Risk assessment in poisoning with special reference to odollam and organophosphorous compounds

Background: Poisoning with organophosphorous compounds, odollam and other substances are common. Affected persons present with a wide variety of clinical features. Prognostic indicators of high mortality are important for management and to decide on intensive care unit admission. Methods: Admissions due to poisonings from April 2015 to March 2016 were assessed. The clinical features, electrocardiographic changes and laboratory investigations of 915 patients were obtained and statistically analysed. Results: The most commonly ingested poisons were odollam (26%) and organophosphorous compounds (22%). The overall mortality was 22%. Mortality was highest in organophosphorus compounds (38%) and odollam (33%) compared to other causes. Hyperkalemia, low systolic blood pressure, consumption of poison in powder or paste form, delayed presentation, bradycardia and extensive chest signs correlated with mortality in odollam and organophosphorous compound poisoning. Conclusions: Poisoning with odollam or organophosphorous compounds is an increasingly common life threatening condition. Markers of mortality identified in this study were incorporated into a simple scale for assessment of risk, namely the PoPPER scale: potassium level >5.5 mE/L, systolic blood pressure <90 mmHg, paste/powder form of poison ingestion, extremely late presentation, rate of QRS <40/min or impending respiratory paralysis. [Int J Res Med Sci 2016; 4(8.000): 3172-3175

Conjunctival impression cytology in contact lens wearers.

PURPOSE: To evaluate the cytological changes in conjunctiva following regular contact lens wear and to determine the correlation, if any, between severity of cytological alteration and symptoms related to contact lens wear. METHODS: One hundred eyes (50 normal asymptomatic subjects) who served as a control group were studied by conjunctival impression cytology (CIC). These subjects were fitted with rigid gas permeable (RGP) or soft contact lenses and were followed up at the end of 3 and 6 months. At each follow-up visit the CIC was repeated. A filter paper with the impression specimen was stained with periodic acid schiff (PAS) and haematoxylin stain to study goblet cell loss. Papanicolaou stain was done to study squamous metaplasia. The cytological changes were graded using the system described by Natadisastra et al. RESULTS: Severity of cytological changes increased with the duration of contact lens wear (P = 0.00001). At the end of 6 months, 60&#x0025; of symptomatic eyes wearing soft contact lens and RGP lens showed abnormal CIC changes. None of the asymptomatic RGP contact lens wearing eyes showed abnormal CIC changes whereas 33.4&#x0025; of the asymptomatic soft contact lens wearing eyes showed abnormal CIC changes (P = 0.033). Epithelial changes occurred within 3-6 months of contact lens fitting. CONCLUSION: Severity of cytological changes increased with duration of lens wear (P = 0.00001). Prevalence and severity of cytological alteration is more in symptomatic contact lens wearers. Soft contact lens wearers although asymptomatic showed severe CIC changes

Flood perception and mitigation: The role of severity, agency, and experience in the purchase of flood protection, and the communication of flood information

Protection of human life and property from flooding is a strategic priority in the UK. We examine how to encourage home owners to protect themselves and their residences. A model of factors that influence the decision to buy flood protection devices is tested using survey data from 2,109 home owners. The results showed that the majority of respondents have not purchased domestic flood protection (N=1,732; 82.1%). Purchase of flood protection devices was influenced by age; perceived seriousness; and beliefs about, and trust in, the role of regulators in managing flooding. In younger respondents, the perceived seriousness of the dangers of flooding acted as precursors and barriers to action depending on individual sense of responsibility and agency. The second part of the study examined responsiveness to information. Information about flooding alone was insufficient to promote behavioural change, particularly among people who have not experienced a flood or who believe that they are not in a flood zone. Implications for understanding flood protection, managing agency issues, and flood communication campaigns are discussed