Search

Introduction: The Kodo Millet crop is known by different names in different regions such as Varagu, Harka and Arikelu. It is predominantly grown in India and commonly consumed. When infected by certain fungus species, the compound cyclopiazonic acid causes the crop to be toxic to humans. Case Report: The following article discusses a case of Kodo Millet poisoning, which is presented with episodes of vomiting, sweating, giddiness and dysphagia. Upon examination, Sinus bradycardia and hypotension were the major findings. The electrocardiograph (ECG) showed sinus brady arrhythmia, which is rarely presented in Kodo Millet poisoning. The emergency physician team treated the patient symptomatically and he was discharged after 24 hours as the symptoms and the ECG findings were reverted. Discussion: Kodo Millet poisoning often occurs due to accidental consumption of infected crops. Its occurrence is rare and the treatment involves only supportive care and monitoring. However, it is important to rule it out as a possible differential diagnosis in similar cases due to other causes. Conclusion: Sinus bradyarrhythmia is a rare condition associated with Kodo Millet poisoning. Emergency physicians should be aware of this toxicity to rule out all other possible differential diagnoses and to provide patients with early treatment. [ABSTRACT FROM AUTHOR]

Background: Ayurveda is one of the traditional medical practices that is originated from India where it is still widely practiced. This study is an attempt to determine the concentration of 6 selected metals, namely chromium, cobalt, nickel, arsenic, mercury, and lead in 19 samples of Ayurvedic herbal medicines and 7 Sindoor powders sent by physicians for analysis. Methods: In this study, ICP-MS as direct analysis of a 1 in 100 dilution of the tested materials was employed which gives an estimate of the solubility of the metal constituents of the materials tested in 0.5% nitric acid. Results: The highest individual metal values found per gram in the tested materials were: chromium 3.2 microgram/g, cobalt 3.1microgram/g, arsenic 2811 microgram/g, mercury 1320 microgram/g, and lead 8329 microgram/g. Assuming only a 1 g intake/day of any single material tested, lead content exceeded in 10/26 (38%) of the preparations above the ANSI 173 oral permitted daily limit (PDE). Likewise, mercury and arsenic contents exceeded the oral PDE in 6/26 (23%). Some of these folk medicines had high levels of more than one element in it. The lead content in 3 of the 7 Sindoor powders surpassed the guideline. However, the nickel content did not exceed the PDE in the 19 samples tested.. Conclusions: Our data shows that, many of Ayurvedic medicine preparations tested still contain toxic amounts of arsenic, mercury, and lead. Sindoor powder which is traditionally and religiously used by many Indian women at their forehead also contains heavy metals like lead. All these materials can pose serious health risks to their users. [ABSTRACT FROM AUTHOR]

Background: Hexaconazole is a category 3/4 of poison as per the W.H.O Expert Group on Pesticide Residues. Hexaconazole is used to control infection by fungi in paddy and other crops. Apart from destroying the target species, it can also cause damage to humans. There have been discrete reports of instances of human poisoning due to hexaconazole. Methodology: A patient record-based cross-sectional study was carried out in Konaseema Institute of Medical Science & Research Foundation, Amalapuram, Andhra Pradesh, India during a period from March 2014 to April 2020 on 26 confirmed cases of hexaconazole poisoning. The clinic-demographic data, hematological, and biochemical parameters at the time of admission and at 72 hrs as well as the outcome were recorded and analyzed using descriptive statistics and paired t test. Result: The prevalence of hexaconazole poisoning was 4.79% of all poisoning cases. The major clinical presentation was gastrointestinal symptoms with vomiting being commonest. There was no significant change in the biochemical and hematological parameters. The mean duration of hospitalization was 4.93+1.39 days. The recovery rate was 100% without any major sequel. Conclusion: Poisoning due to hexaconazole is uncommon in comparison to poisoning by other pesticides in the agricultural community. The clinical manifestations of hexaconazole poisoning indicated that it is of non-serious nature and its recovery was without any sequel. [ABSTRACT FROM AUTHOR]

Introduction: In remote areas of India, folk medicine by local unregistered practitioners is quite common. Such practitioners use Sindoor or Vermillion, or Kumkum in their medicinal preparations to cure chronic ailments like joint pain, infertility, asthenia, impotence, and immunological disorders. Traditional Indian Vermillion is prepared using lime (calcium component) mixed with various natural ingredients like camphor, oil, agaru, sandalwood paste, and turmeric. However, modern-day commercial Vermillion contains Lead tetroxide. The use of such lustrous synthetic Vermillion that contains Lead salts in folk medicine may cause Lead intoxication among the consumer tribal population. Case Report: The case of a 51-year-old male admitted to our tertiary care institute with colicky abdominal pain and quadriparesis and a history of chronic tea intake containing synthetic Vermillion and turmeric as prescribed by local folk medicine practitioners is presented. Discussion: People in remote areas of the tribal-state of Chhattisgarh (India) often consult a local traditional healer first and report to a modern health facility when things go out of hand. The instant case presented after development of quadriparesis, dysphagia, and dysphonia. He was diagnosed as a case of Lead toxicity based on clinical suspicion corroborated by blood Lead levels and was conservatively managed with BAL leading to satisfactory recovery. Conclusion: In the case of Lead toxicity, early diagnosis, careful evaluation of complications, and immediate treatment are very important. As a preventive measure, medical systems need to educate and collaborate with traditional practitioners in the best interest of tribal people residing in remote areas of India. [ABSTRACT FROM AUTHOR]

Background: Patients presenting to Emergency department following consumption of toxic substances is not an uncommon phenomenon globally. It becomes essential for the Emergency physicians to have in-depth knowledge of all the toxic products available in their locality. In rural parts of South India, the most common method of poisoning is by consumption of pesticides, followed by plant poisons, because of its easy availability. Gloriosa superba is an important medicinal plant growing in several parts of Southeast Asia. All parts of this plant contain several alkaloids including colchicine with the highest concentration in seeds and tubers. Acute intoxication following ingestion of G. superba is indistinguishable from colchicine overdose. Clinical presentation: The symptoms of intoxication can be classified in three phases. Phase 1:(2-24 hours) early gastrointestinal symptoms mimicking gastroenteritis, volume depletion, hypotension, peripheral leucocytosis; Phase 2:(24 to 72 hours) mental status changes, oliguric renal failure, hematopoietic problems, electrolyte imbalance, acid-base disturbance, shock, bone marrow suppression, liver failure, ARDS, arrhythmias, cardiovascular collapse, encephalopathy and neuromuscular involvement; and Phase 3:(1-3 weeks) Recovery typically occurs within few weeks of ingestion but with rebound leucocytosis and alopecia. Case report: We present a patient who ingested Gloriosa superba tubers with suicidal intent and developed acute fulminant liver failure a week after ingestion. Two weeks later, he also developed alopecia. Liver functions gradually improved and normalized after three weeks of hospitalisation. He was provided supportive treatment and he improved remarkably. At discharge, total bilirubin was 1.3 mg/dL, direct bilirubin 0.6 mg/dL, serum urea 15mg/dL and serum creatinine 0.9 mg/dL. On follow-up visits, alopecia showed an improving trend. Conclusion: Colchicine exerts a multiorgan toxicity. Acute fulminant hepatic failure can be a life threatening manifestation of Gloriosa superba poisoning. Hepatic failure can be due to colchicine induced direct hepatic injury with cytolysis. Management is essentially supportive with anecdotal reports showing benefit in plasmapheresis. [ABSTRACT FROM AUTHOR]

Background: The National Crime Records Bureau of India reported a decline in suicide rate from 2010 through 2014. We conducted this study to know whether our hospital data reflects the national data and to know the age and gender specific differences in selecting methods of suicide. Methods: We conducted a retrospective analysis of autopsied cases in Department of Forensic Medicine in a tertiary care hospital in central Kerala, India. Data on age, gender, cause of death of autopsied cases with alleged history of deliberate self-harm (DSH) were noted. Results: Mean age of study population was 43.4±24.4. There were 59.3% males and 40.7% females, but young females outnumbered young males. Majority of cases were hanging (n=1325), followed by poisoning (n=1169), burns (n=809), drowning (n=626) and others (n=401). Hanging and poisoning were the common methods chosen by males while burns and poisoning were the common methods by females. The number of DSH cases was 1,040, 866, 771, 837 and 826 in each year from 2010 to 2014, respectively. Number of poisoning cases was declining steadily from 350 to 163 while non-poisoning suicide was not showing any steady changes (690, 578, 514, 657, and 663). Pesticides were the most common agent recorded in the autopsy sheet while corrosives, plant toxins, cyanide, toxic alcohol and drug overdose were less common. Quinalfos, chlorpyrifos and carbofuran were the commonly identified pesticides on chemical analysis. Conclusion: There is a decrease trend in the number of suicides over the 5 years from 2010 through 2014 with a decrease in suicide due to poisoning. Though there is minimal increase in suicide due to hanging, it did not affect the total number of suicides. [ABSTRACT FROM AUTHOR]

Background: Suicide by poisoning is the second most common cause of death by suicide (27.9%) as per The National Crime Records Bureau (NCRB) India in 2015. Aluminum phosphide (ALP) is the leading agricultural poison used to commit suicide as where its availability is not properly regulated. ALP is a highly toxic solid fumigant pesticide, rodenticide and insecticide. Case presentation: A 40-year-old woman was brought by the police to the emergency section. Her extremities were cold and hypotonic, and her skin was pale. Patient’s vitals were unstable with pulse rate 112/minute irregularities, blood pressure 68/54 mm of Hg, respiratory rate 22/minute shallow and body temperature 30.1 ºC and characteristicly strong garlicky odor on her breath. During the suction of gastric contents, spontaneous ignition of gas with flames and white fumes with sound like a blast was observed by resident doctors and para-clinical staff. Gastric aspirate along with Ryle’s tube were immediately sent to the forensic department where the Silver Nitrate test was performed and it was found strongly positive for phosphine gas. Discussion: Aluminum phosphide readily reacts with water and hydrochloric acid in the stomach to produce phosphine (hydrogen phosphide, PH3) and a small amount of diphosphine. Conclusion: The present case report stresses on the need that the emergency physicians need to be highly alert and adequately prepared while handling such patients. Spontaneous ignition with the release of phosphine from ALP poisoned patients can not only affect the patient, but also pose a health hazard to emergency physicians and medical staff. [ABSTRACT FROM AUTHOR]

Background: Organophosphorus compound ingestion is one of the most common modes of deliberate self-harm in developing countries like India. Neurological complications are known in acute, intermediate and delayed phases following organophosphate poisoning. However, extrapyramidal manifestations are rarely reported. Case presentation: A 30-year-old male patient was brought to the emergency department with history of consumption of unknown amount of monocrotophos 36%. At the time of presentation, he was in cholinergic crisis. He was managed with intravenous satropine, pralidoxime and mechanical ventilatory support. By day six, he improved significantly and was extubated. On day eight of illness, he developed extrapyramidal syndrome (EPS) characterized by reduced facial expression, tremors of all four limbs, rigidity and intermittent opisthotonic posturing. In addition to supportive care, he was treated with oral amantadine and trihexyphenidyl. He was discharged on day fifteen and by eight weeks improved significantly and became independent for all activities of daily living. Discussion: Organophosphorus compounds are cholinesterase inhibitors which act primarily by blocking active site on the cholinesterase enzyme by forming a covalent bond. Extrapyramidal syndrome is a rare complication during intermediate phase. Increased susceptibility of the basal ganglia nuclei to the toxic products in the absence of efficient detoxification pathways may be responsible. Brain imaging may reveal characteristic signal changes or can be completely normal. Conclusion: This case highlights the importance of careful observation and meticulous neurological examination for the diagnosis and appropriate management of the rare extrapyramidal syndrome due to acute organophosphate poisoning. [ABSTRACT FROM AUTHOR]