A retrospective analysis of acute organophosphorus poisoning cases admitted to the tertiary care teaching hospital in South India

Objectives: We have herein reported our experience with the pattern of presentation of cases of acute organophosphorus (OP) poisoning cases in a tertiary care hospital.Materials and Methods: This retrospective study evaluated the hospital records of patients with acute OP poisoning. In a pre-structured proforma, data regarding age, sex, time elapsed after intake, circumstances of poisoning, duration of hospitalization, severity, complications, and outcome of the patients were recorded. The data were presented as mean ± standard deviation, entered in the open office datasheet, and analyzed with PSPP software.Results: A total 101 patients were included in the study. Young adult males were more commonly involved than females (M:F 2.5:1). The mean age of the patients was 28 years (range 2-72 years, SD ± 14.3 years). Mean time to receive treatment was 5.2 ± 7.4 (range 1-48 h). About 45.5% patients received first aid before coming to the hospital. The reason was suicide in 88.1% cases and accident in 12 (11.9%, all children). Seventy-nine  patients received pralidoxime (PAM) and the mean duration was 1.7 ± 1.1 (range 1-4 days). Atropine was given in all patients. Mean duration was 5.1 ± 3.1 (range 1-19 days). Mean hospital stay was 7.5 ± 4.7 days (range 1-26 days). Mortality was 9.9% in the present series.Conclusion: Although the present study contribute substantial information regarding the epidemiology and outcome of acute OP poisoning in a tertiary care teaching hospital at a district level, its relatively small sample size and the retrospective record-based nature are the major limitations of the present study. There is a further need for prospective studies to understand the underlying socio-economic factors responsible for acute OP poisoning in our population, and, accordingly, address the problems to reduce the incidence of acute OP poisoning cases.Keywords: Acute poisoning, organophosphate poisoning pattern, outcome, tertiary care hospita

Evaluation of ultrasound guided verses nerve stimulator technique of interscalene brachial plexus block: insights from Indian multi-super specialty hospital

Background: To provide adequate intraoperative anaesthesia and postoperative analgesia for orthopaedic surgery continues to be a procedural challenge. The administration of brachial plexus anaesthesia can be facilitated through nerve stimulation or by ultrasound guidance. Hence study was conducted to compare differences in these techniques in patients undergoing interscalene brachial plexus block (ISSB).Methods: In this prospective, randomized, observer-blinded study, 60 patients (Male=41, Female=19) were scheduled for orthopaedic shoulder and upper arm surgeries matching inclusion and exclusion criteria. Patients were randomly allocated to either Ultrasound (US, n=30) group or Nerve Stimulator (NS, n=30) group through a computer-generated randomization.Results: There was significant difference between US and NS group with respect to average number of attempts taken, block performance time (BPT), onset of sensory and motor block, duration of motor block and patient satisfaction score. Whereas not much significant difference was observed in duration of sensory block, block success rate and incidence of post operative side effects.Conclusions: The results suggest that US guided ISBB is significantly superior to NS guided block in terms of faster onset of action; lower number of attempts to locate Interscalene brachial plexus; longer duration of block and overall success rate with favourable tolerability at real-life scenario

Intrathecal baclofen in management of a patient with very severe tetanus

Tetanus is uncommon in developed countries. The majority of tetanus cases occur in third world countries and 50% of these cases occur in neonates. There are more than 800,000 deaths due to tetanus each year in the world. We present a case of 40-year-old male patient diagnosed to have very severe tetanus - Grade IV as per Ablett classification of severity, managed in our hospital with aggressive treatment for 27-days and use of intrathecal baclofen he showed drastic improvement in this status.  He was discharged in neurological intact conditions with hemodynamic stability.

Modifiable determinants of attitude towards dengue vaccination among healthy inhabitants of Aceh, Indonesia: Findings from a community-based survey

Objective To explore and understand the attitude towards dengue vaccination and its modifiable determinants among inhabitants of Aceh (northern Sumatra Island, Indonesia), the region that was most severely affected by the earthquake and tsunami of 26 December 2004. Methods A community-based, cross-sectional study was conducted among 535 healthy inhabitants in nine regencies (Kabupaten or Kotamadya) of Aceh that were selected randomly from November 2014 to March 2015. A set of validated, pre-tested, structured questionnaires was used to guide the interviews. The questionnaires covered a range of explanatory variables and one outcome variable (attitude to dengue vaccination). Multi-step logistic regression analysis and Spearman's rank correlation were used to test the role of explanatory variables for the outcome variable. Results More than 70% of the participants had a poor attitude towards dengue vaccination. Modifiable determinants associated with poor attitude to dengue vaccination were low education level, working as farmers and traditional market traders, low socioeconomic status and poor knowledge, attitude and practice regarding dengue fever (P < 0.05). The KAP domain scores were correlated strongly with attitude to dengue vaccination, rs = 0.25, rs = 0.67 and rs = 0.20, respectively (P < 0.001). Multivariate analysis found that independent predictors associated with attitude towards dengue vaccination among study participants were only sex and attitude towards dengue fever (P < 0.001). Conclusions This study reveals that low KAP regarding dengue fever, low education level and low socioeconomic status are associated with a poor attitude towards dengue vaccination. Therefore, inhabitants of suburbs who are working as farmers or traditional market traders with low socioeconomic status are the most appropriate target group for a dengue vaccine introduction program

Correlates of caregiving burden in schizophrenia:A cross-sectional, comparative analysis from India

Schizophrenia is a global mental health issue that has serious implications not only for the person with the diagnosis, but for caregivers as well. In Asian societies, the family tends to be the “natural” caregiver in such situations and the caregiving function is usually shouldered by parents or the spouse. Asian communities tend to be more closely knit, and it would be expected that more social support would be available to those facing distressing circumstances such as managing the demands of a person with mental illness. This study seeks to explore the perceived burden in family caregivers of persons diagnosed with schizophrenia, the coping strategies that come into play, as well as the extent of social support available to them. Standardized instruments were administered to collect data at a teaching cum treatment facility in south India. A quantitative methodology was used to analyze cross-sectional data from 75 primary caregivers of people with a diagnosis of schizophrenia and a reference group of caregivers of patients with general medical ailments. Results indicate high levels of burden, low social support, and poor coping in the caregivers of people with schizophrenia than the reference group. Implications for intervention with caregivers are also discussed in this article