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Background: In a developing country such as India, intentional poisoning is associated with a high degree of morbidity and mortality. Historically, the use of agricultural poisons for attempted deliberate self-harm (DSH) has taken precedence. However, urbanization and stringent laws governing sale of agricultural chemicals, in recent years, may have shifted the focus of seekers toward commercially available therapeutic medications. Further, urbanization, high health-care seeking behavior, and poor regulation on sale of medicines, in Kerala, provide a conducive environment for such attempts. Aims and Objectives: The objective of this study was to determine the contribution of therapeutic medication toward acute poisoning as a means of DSH and the factors contributing to the same. Materials and Methods: Patients who obtained treatment for acute poisoning after DSH, between 2017 and 2023, were screened, those who employed therapeutic medication for the same were further determined. Sociodemographic details, clinical profile, and history of previous such attempts and treatment history including toxicological screening report were gathered and analyzed. Results: In our study of 154 patients arriving at the emergency department with history of DSH, 41% used therapeutic medicines for the same. Majority were women (75%) and most had a high school education (64%) or above. The most common agents were determined as paracetamol (23%) and benzodiazepine (10.6%). Tox screen was performed for 45% of patients. Organ failure developed in 36% patients with drug levels above and 42% of those with levels below the therapeutic range. However, 48% of those who did not undergo toxicological screening developed organ failure. Organ failure developed in 42% of patients, with acute liver injury being the most common culprit (25%). Management was symptomatic unless an antidote was available. Conclusion: Prescription drugs utilization for DSH was common in women and patients with higher educational status. Over-the-counter drugs and psychiatric medication were frequently used. Lack of prompt access to healthcare may contribute to organ failure. Tox-screen is recommended for drug detection. [ABSTRACT FROM AUTHOR]

Aflatoxin (AF) poisoning of staple foods, such as rice, is caused by fungal contamination by Aspergillus species. These AFs are genotoxic, carcinogenic and suppress the immune system. Hence, the present study was conducted to elucidate the prevalence of AF contamination in rice samples collected from local markets of Hyderabad, Telangana, India. The rice samples collected were analysed for AF by using HPLC-fluorescence detection (HPLC-FLD). Based on AF contamination levels and dietary intake of rice, the health risk was assessed by the margin of exposure (MOE) and liver cancer risk in adults, adolescence and children. The percentage detected contamination with AFB1 and AFB2 of rice samples was 54% and 34%, with the concentration ranging between 0–20.35 µg/kg and 0–1.54 µg/kg, respectively. Three rice samples exceeded the Food Safety and Standards Authority of India (FSSAI) total AF acceptable limit of 15 µg/kg. The average MOE values were 53.73, 50.58 and 35.69 (all <10,000) for adults, adolescence and children, respectively. The average liver cancer risk associated with rice consumption in the population of Hyderabad was found to be 0.27, 0.28 and 0.40 hepatocellular carcinoma (HCC) cases/year/100,000 individuals in adults, adolescence and children, respectively. This study revealed an adverse health risk to population of Hyderabad due to consumption of AF contaminated rice. [ABSTRACT FROM AUTHOR]

Aims and background: Acute poisoning is one of the most common emergencies in India and around the world. Understanding the factors associated with mortality can aid us in devising appropriate preventive strategies to curtail deaths due to poisoning. Purpose of this study is to find various factors that determine the mortality among acute poisoning cases admitted in a tertiary care center. Materials and methods: A retrospective hospital records-based study was conducted at Chengalpattu Medical College Hospital. The study included 2,123 cases of various poisoning cases admitted for a year from January to December 2022. Cases of bites, stings, drowning, and hanging were excluded. Information on sociodemographic profile, type of poison, time since ingestion and admission, and treatment outcome were collected using a structured pro forma. Results: The mean age of the study population was 29.90 ± 14.98 years. Poisoning was found to be predominantly among males (56.42%) and residents of rural areas (58%). Insecticide consumption (27.0%) was the most common modality, followed by oleander poisoning (20%), corrosive poison (17%), rat poison (15%), tablet poison (13%), and other poisons. The overall case fatality rate (CFR) was 5.2%, with the highest CFR of 12.25% with insecticide poisoning. In multivariate analysis, Glasgow coma scale (GCS) score at admission is the only parameter showing a statistically significant association with mortality (adjusted odds-ratio 0.271(0.2-0.38, p-value < 0.01). Conclusion: Acute poisoning primarily affects the young and economically productive population. In the south Indian population, pesticides are still the major contributor though corrosives are a major contributor among children. Mortality is still significant, and GCS status admission is the only predictor of mortality. [ABSTRACT FROM AUTHOR]

Background: Copper (Cu), an essential trace element, is toxic if consumed in excessive amounts. Ruminants, particularly sheep, are highly susceptible to chronic copper poisoning and cause acute death. Spontaneous copper poisoning in sheep was reported from many parts of the world however limited reports are available from India. Hence the present investigation was undertaken to report the occurrence of chronic copper poisoning in an intensively maintained Pattanam breed of sheep flock and its therapeutic management. Methods: An investigation was carried out to ascertain the possible cause of increased mortality in an intensively maintained 130 male lambs aged between 8 to 10 month old belongs to Pattanam breed during the month of September 2020 following death of 21 animals within a period of 15 days. Affected flock was inspected and samples were collected for biochemical analysis, toxicological, bacteriological and pathological examination. Result: Affected animals showed depression, anorexia, jaundice, hemoglobinurea and accelerated breathing. At necropsy, the dead animals showed generalized icterus, lung edema, yellow to orange coloured liver and gun metal kidney. Histopathological lesions include lung edema, centrilobular hepatic necrosis, bile stasis, renal tubular necrosis and formation of tubular cast. Toxicological analysis of liver revealed the copper level of 781 mg/kg dry matter basis. Source of copper was identified as a commercial mineral mixture supplement intended for cattle was supplemented along with concentrate feed. The flock was treated with chelating agent (D-penicllamine) and supportive therapies. [ABSTRACT FROM AUTHOR]

Introduction: Snakebites pose a significant public health challenge globally, with India hosting over 250 venomous snake species. This study focuses on four major venomous land snakes, including the saw-scaled viper, responsible for numerous incidents worldwide. Snakebites result in millions of cases annually, with India reporting a substantial number, though the actual incidence and mortality rates may be underestimated due to traditional treatments in rural areas. Objective: The research aims to evaluate clinical parameters in patients with poisonous snakebites, emphasizing clinical predictors of mortality. Methodology: Conducted at a Medical College and Hospital from January to November 2023, the study involved 432 snakebite patients, with 260 exhibiting envenomation signs. Clinical criteria and treatments were standardized, and patient outcomes were monitored. Statistical analysis utilized SPSS version 26.0. Results: Among 260 patients, 58 did not survive, resulting in a mortality rate of 22.3%. No significant age or gender differences were observed between survivors and non-survivors. Rural areas accounted for a higher incidence, and September had the peak admission of patients. Lower limbs were predominantly affected (75.8%). Local pain and swelling were common symptoms. Bleeding tendencies, respiratory failure, and shock were associated with higher mortality. Discussion: Mortality rates varied, and factors like delayed hospital arrival, respiratory failure, acute renal failure, severe coagulopathy, and shock were identified as contributors to death. The study highlighted the correlation between mortality and complications such as bleeding tendencies and respiratory failure. Conclusion: The study concludes that predicting mortality in snakebite patients is feasible using straightforward variables like bleeding tendencies, respiratory failure, and shock. These findings can aid healthcare practitioners in directing high-risk cases to advanced facilities promptly. Availability of Anti-snake venom at Primary Health Centers and raising awareness about prompt hospitalization can improve outcomes. [ABSTRACT FROM AUTHOR]

Introduction: The aim of this study was to determine the clinical predictors of staphylococcal ventilator-associated pneumonia (VAP) and to compare the outcomes of staphylococcal VAP with non-staphylococcal VAP. Methodology: A retrospective observational study was conducted among adult patients admitted to the medical intensive care unit (MICU) in a tertiary care hospital in India from January 2017 to December 2019. The patients were grouped based on their diagnosis into staphylococcal and non-staphylococcal VAP, and the baseline characteristics, clinical parameters, co-morbidities, and outcome parameters were compared. Results: Out of 2129 MICU admissions, 456 patients with microbiologically confirmed VAP were included, of which 69 (15.1%) had staphylococcal VAP, and the remaining 387 (84.9%) had non-staphylococcal VAP. Organophosphorus (OP) poisoning was identified as an independent predictor of staphylococcal VAP (odds ratio: 2.57; 95% CI: 1.4 to 4.73). The median duration of mechanical ventilation before VAP diagnosis was less in the staphylococcal VAP group (4 vs. 5 days; p = 0.004). The staphylococcal group also showed a better in-hospital outcome. Conclusions: OP poisoning was an independent predictor of staphylococcal VAP. Staphylococcal VAP was diagnosed earlier in patients than non-staphylococcal VAP. Screening for nasal carriage for Staphylococcus, especially in patients with OP poisoning at the time of MICU admission, may help guide antibiotic therapy. [ABSTRACT FROM AUTHOR]

Introduction: Acute poisoning in children is an important public health problem. It is a significant paediatric emergency in both developing and developed countries, leading to preventable morbidity and mortality. While there is substantial research literature on acute childhood poisoning from developed countries, there is a lack of data from developing countries like India due to inadequate and poor surveillance of poisoning-related data. Aim: To investigate the clinical and epidemiological profile, as well as the outcome, of acute poisoning in children admitted to the paediatric emergency department of a tertiary care hospital in Northeast India. Materials and Methods: This prospective cohort study was conducted in the Paediatrics department of Assam Medical College and Hospital, Dibrugarh, Assam, India, from April 1, 2021, to March 31, 2022. All children under the age of 12 years who presented to the paediatric department with a history of exposure to toxic substances were included in the study. The admitted children were assessed in terms of demographic variables, type of poison, route of poisoning, time of presentation, circumstances of poisoning, storage place of poison, clinical presentation, and interventions provided. Data were presented as mean and frequency. Results: A total of 78 children under 12 years of age were enrolled in the study, with a mean age of three years and three months at presentation. The majority of cases (96.2%) involved accidental poisoning, while a small proportion (3.8%) was due to suicidal poisoning. Of the two reported cases of suicidal poisoning, one involved a male child and the other involved a female child. Both children were above six years of age. The most common causes of poisoning were kerosene (34.6%), organophosphorus compounds (10.3%), and liquid mosquito repellents (9.1%). Conclusion: This study revealed both unintentional and intentional poisoning cases, with a high prevalence of accidental poisoning observed in children below three years of age. Kerosene was identified as the most common cause of childhood poisoning. [ABSTRACT FROM AUTHOR]

Background and objectives: Neonicotinoids are a newer class of pesticides that are believed to cause predominantly mild toxicity in humans. This study aimed to describe the clinical features of neonicotinoid poisoning and identify predictors of severe toxicity. Materials and methods: This retrospective study included all patients with neonicotinoid poisoning admitted to a Tertiary Care Center in India over an 18-year period. Clinical and laboratory features were compared against outcomes to identify predictors of the need for intensive care admission. Results: Twenty-eight patients were included in the study of which 28.6% had severe disease requiring ICU admission. A higher respiratory rate, blood lactate level, SOFA, and qSOFA scores as well as a lower Glasgow coma score at presentation predicted ICU admission. First-generation compounds and imidacloprid consumption were associated with longer ICU stays and a longer duration of invasive ventilation. Conclusion: Neonicotinoid compounds can cause significant toxicity with oral ingestion. Imidacloprid and other first-generation compounds were associated with more severe toxicity requiring intensive care. Simple clinical parameters assessed at presentation can be used to predict severe disease and the need for ICU care. Larger, prospective studies are required to confirm these findings. [ABSTRACT FROM AUTHOR]

Background: Acute poisoning is a major health problem with significant morbidity and mortality affecting people of all age groups. Acute poisoning approximately constitutes 10% admissions in medical emergency departments in India. Objective: Present study was aimed at finding out the clinical pattern and outcome of acute poisoning at a tertiary care hospital, Karnataka. Materials and methods: A prospective observational study was conducted over a period of 18 months. Information like name of poisonous substances, mode of poisoning, investigation reports and outcome was collected in the pre-structured proforma and analysed using SPSS version 20. Results: Out of 100 acute poisoning cases, 49 were males and 51 females. Most common age group involved was 21-30 years of age (38%). Organophosphate poisoning was the most common type of poisoning. Mortality was highest in paraquat poisoning (100%). Overall mortality was 15%. Conclusion: Current study showed increase in incidence of poisoning in younger generation. Organophosphate poisoning was the most common type of poisoning. Low cost and easy accessibility of OP compounds may be one of the reasons. Rat poisoning, usage of household cleansing agents and corrosive poisons (paraquat) are also in increasing trend. [ABSTRACT FROM AUTHOR]

Introduction: Organo-phosphates are widely used in horticulture and agriculture in developing countries and therefore poisoning with these agents is common either by unintentional or suicidal ingestion. In developing countries like India, it is still a major public health problem because of its association with high morbidity and mortality. Organo-phosphates may cause deformation of erythrocyte membranes by acute and chronic inflammation. Hence, it is expected that Red cell distribution width (RDW) levels may be increased in Organophosphorus (OP) poisoning and can thus aid in prognosis. Objectives: 1. To assess red cell distribution width and serum cholienesterase levels on admission. 2. To assess correlation between red cell distribution width and outcome in organophosphorus poisoning. Methodology: A prospective interventional study was conducted among 100 Organophosphorus poisoning cases admitted in our hospital. A detailed history was obtained using a pre-designed, structured proforma followed by a detailed systemic examination. Relevant investigations were conducted which included red cell distribution width. Chi-square test was used to assess the relation between red cell distribution width and outcome in organophosphorus poisoning. Results: Among 100 participants, majority were males (65%) and between 21-30 years age group (43%). Most common compounds involved in poisoning wereMonocrotophos (36%) Chlorpyrifos (34%), Duration of exposure for 69% of them was 1-2 hours. 50% of them had RDW ≤ 13 and 50% had RDW > 13. There were 6 deaths among 50 subjects with RDW >13 and only 1 death among 50 subjects with RDW ≤ 13 and this difference was statistically significant (P<0.05). Conclusion: In this study RDW was significantly associated with outcome and served in assessing the outcome in OP poisoning. We conclude that RDW is simple test which can be measured easily at the time of admission and used as a predictor of outcome in OP poisoning. [ABSTRACT FROM AUTHOR]

Background and Objectives: Organophosphorus compounds have assumed considerable importance in most parts of the world. Though these compounds were discovered a century ago, even now they are the widely used insecticides all over the world. Aims and objectives of these study was to assess serum creatine phosphokinase level in OP poisoning. Material and Methods: The present study was conducted on a sample of 50 patients who were admitted to Department of General Medicine, SVS Medical College and Hospital Yenugonda, Mahbubnagar, Telangana, 509001, India, exhibiting a documented history and clinical manifestations consistent with organophosphate poisoning. Study was conducted between the April 2023 to September 2023. Results: Organophosphorus chemicals are often employed substances for self-harm due to their widespread accessibility. The primary determinants of death encompass the specific toxic chemical employed, the extent of poisoning, the timing of treatment initiation, and the availability of intensive care resources. Although acetylcholinesterase has several advantages, it can result in an overstimulation of muscarinic and nicotinic receptors. The clinical presentation of cholinergic crisis typically manifests rapidly, serving as the primary basis for clinical diagnosis. Confirmation of this diagnosis is typically achieved by the patient's medical history and the use of demonstrative monitoring. Conclusion: The study observed that following treatment, levels of creatine phosphokinase returned to baseline levels, accompanied by a subsequent enhancement in the patient's clinical state. The optimization of the mean dose and duration of Atropine and pralidoxime treatment is a topic of interest, as it has been seen that greater doses are required in severe instances. [ABSTRACT FROM AUTHOR]

Background: Organophosphorus (OP) compounds are widely used in India as insecticides and contribute to both acute and chronic poisoning. Several parameters have been analyzed to evaluate the severity of poisoning and to prognosticate the outcome but contradictory results have been obtained from studies for example for the relationship between hypokalemia and outcome, pseudocholinesterase (PChE) levels, and outcome. Aims and Objectives: The objectives of this retrospective study were to explore the epidemiological characteristics and clinical profile of patients admitted to intensive care unit with OP poisoning and to evaluate the outcomes including complications, in hospital mortality, and the predictors of mortality. Materials and Methods: All the patients above 18 years admitted with a history of ingestion of OP poisoning during the study period were included in the study. Data were collected from case records. Results: The mean age of the patients was 34±13.54. Fifty-four patients were male (69.2%) and 24 were female (30.8%). The correlation coefficient between intubation and PChE levels was 0.266. The mean period of ventilation was 4.16 days±2.41 days. About 80% (n=20) put on ventilator survived. Correlation of hypokalemia with patients getting ventilator support was 0.26 and that with mortality was 0.038. Conclusion: OP poisoning cases were primarily noted in the younger male group with the intent to self-harm. Chlorpyrifos was the most common compound consumed. Early admission and appropriate treatment can reduce mortality and complications as there is no single factor which can be used to predict the outcome in these patients. [ABSTRACT FROM AUTHOR]

Cleistanthus collinus is a poisonous shrub commonly used for deliberate self-harm in rural south India. Boiled decoction or a paste made from its leaves is used for suicide. Cleistanthoside A and Cleistanthin A are the major toxins identified from this plant. In this study, we disclose the mechanism of Cleistanthin A toxicity and concentrations of the two toxins in different extracts of Cleistanthus collinus. The effect of Cleistanthin A was studied on isolated goat leg arteries using two different preparations namely transverse cylinder and longitudinal strip. The influence of Cleistanthin A on peripheral vascular resistance and myocardial contractility was evaluated by rat hind limb and isolated rat heart experiments, respectively. For the quantification of toxins, five different extracts of C. collinus leaves were prepared. The extracts were subjected to analytical HPLC to quantify Cleistanthoside A and Cleistanthin A. Cleistanthin A increased vascular tension in transverse cylinder preparation and increased peak, trough and mean aortic pressures in the rat hind limb preparations. In isolated rat heart experiments, there was an increase in diastolic and mean ventricular pressure with a significant decrease in ventricular pulse pressure. These observations suggest that the hypotension in C. collinus poisoning patients may be due to cardiotoxicity and not due to vasodilation as is currently believed. Quantification of different extracts showed that boiled extracts had higher quantities of Cleistanthoside A whereas crushed leaf extracts yielded significantly higher amounts of Cleistanthin A. [ABSTRACT FROM AUTHOR]

Background: Organophosphorous (OP) compound poisoning is a common toxological emergency in agricultural country like India, as it is easily available. Cardiac Marker (CPKMB &Trop-I) level were frequently elevated in OPC poisoning and ECG changes were observed. Fatality is mostly due to cardiovascular and respiratory failure. Aim & Objective: To study clinical severity and it's correlation to myocardial injury in respect to Troponine-I, CPK-MB and ECG changes. Material and Methods: A prospective observational study conducted among 97 patients admitted in Medicine Department, VIMSAR, Burla with history of OPC poisoning during the period of Dec 2019 to Dec 2021 after approval from institutional Ethical Committee. Changes in ECG, Serum CPK-MB, Trop-I level were estimated by IFCC and ELISA method, respectively and observed at admission, after 3 days and at discharge. Results: Mostly Chlorpyriphos (23.7%) was consumed followed by Phorate (22.7%). The most common clinical symptoms was bradycardia (49.5%) followed by hypotension (26.8%), and tachycardia (21.6%). Acetylcholine esterase level decreased (<25000IU) in 75.3 % patients. ECG showed Sinus bradycardia (44.3%), followed by QT prolongation (33%). On day3, significantly elevated Trop-I (27.80 %) and CPK-MB(29.89%) were found. Conclusion: Majority of the patients were in the age group of 45-60 with males more than females. Occurrence of cardiotoxicity was related to the type of compounds ingested. Elevated CPK-MB and Trop-I indicates severity of OPC poisoning requiring longer ICU stay and also statistically significant to predict the prognosis of poisoning. [ABSTRACT FROM AUTHOR]

Restricting access to suicide methods is one of the most effective suicide prevention approaches. Trends in method specific suicide rates (2014–2021) in India were calculated using National Crime Records Bureau data (NCRB) by sex and geographical region. Joinpoint regression analysis was used to empirically identify any changes in suicide trends. Suicide rates by hanging increased from 6.08 to 10.0 per 100,000 population among males and from 2.55 to 3.56 per 100,000 among females over the study period. Insecticide poisoning suicide rates also increased from 1.51 to 2.73 per 100,000 among males and from 0.74 to 1.14 per 100,000 among females. Suicide by self-immolation decreased over the study period among both sexes. In general, these national trends were mirrored among different regions. Joinpoint regression indicated an increase in suicide by hanging (annual percentage change (APC) of 12.3 among males between 2018 and 2021 and 4.9 among females between 2014 and 2021) and an increase in male suicide by insecticide poisoning between 2014 and 2021 (APC of 4.2) while a decrease in self-immolation rates was noted among males (APC of −12.7 between 2014 and 2021) and females (APC of −16.5 between 2016 and 2021). The NCRB data might underestimate true suicide rates. Hanging suicides and insecticides poisoning suicides observed an increasing trend between 2014 and 2021. Self-immolation rates decreased during the study period which might be, in part, associated with the initiative to provide clean cooking fuel to households. Ban on lethal pesticides must be prioritised which might help lower insecticide poisoning suicide rates. • Hanging had the highest method specific suicide rate among both sexes showing a consistent rise over the study period • Suicide by insecticide poisoning also showed an increasing trend over the study period, especially among males • Suicide by self-immolation decreased over the study period among both sexes • Government's initiative to provide clean cooking fuel to rural households might have helped reduce self-immolation rates • It is imperative that lethal pesticides are banned in India which might help reduce insecticide poisoning suicides [ABSTRACT FROM AUTHOR]

Introduction: Poisoning in children is an important paediatric emergency and a worldwide problem. Poisonings from intentional substance abuse, as well as unintentional toxic exposures, remain significant health concerns for hospital emergency admissions. Understanding the precipitating causes and providing timely counseling play a key role in preventing intentional poisoning in adolescents. Aim: To study the profile of acute self-poisoning in adolescents and factors associated with poisoning. Materials and Methods: A hospital-based prospective cohort study was conducted at Vanivilas Hospital, which is affiliated with Bangalore Medical College and Research Institute in Bengaluru, India. The study duration was from November 2018 to June 2020. The study included 100 adolescents, aged 10-18 years, who were admitted with a history of poisoning during the 18-month study period. Informed consent was obtained, and participants were followed-up until discharge. Data was collected using a proforma that included demographic details, information about poisoning, examination findings, investigations, and treatment given. The data was analysed using descriptive statistics, and the Chi-square test was used to determine associations between variables. Results: The mean age of the study participants was 15.48 years. The maximum number of cases, 53 (53%), were seen in the 13-16 years age group, followed by 36 (36%) in the age group of 17-18 years, and 11 (11%) in the age group 10-12 years. There were 33 (33%) male children and 67 (67%) female children. In the present study, 43 (43%) children belonged to the insecticide group, 30 (30%) to the drugs group (most of them were in combination), 14 (14%) to the household group, 4 (4%) belonged to both the plant and unknown group, and 2 (2%) belonged to the corrosive, and 1 (1%) each for herbicide, hydrocarbon, and metal groups. A total of 87 (87%) cases were discharged after completion of treatment, 8 (8%) cases were discharged against medical advice, and the mortality rate was 5 (5%). The majority of the cases, 79 (79%), consumed poison as an impulsive act secondary to conflicts among family members. Conclusion: The present study found that acute poisoning in adolescents is mostly intentional, with insecticides being the most commonly implicated agents. [ABSTRACT FROM AUTHOR]

Background: Acute iron toxicity is fatal in children resulting from an accidental overdose of maternal iron tablets at home. There is scanty literature on children looking at the profile and outcome. We report a case series of five children presenting after accidental ingestion of iron tablets. Two presented with fulminant hepatic failure at 48 h, and despite supportive management and plasmapheresis in one child, both succumbed to illness. Materials and Methods: This retrospective study was conducted in the pediatric intensive care unit (PICU) of a teaching institution in South India between January 2009 and December 2019. All children with accidental iron poisoning were included in the analysis. Results: During the study period, five children presented to our PICU after accidental iron tablet ingestion. The mean age was 25.8 months [standard deviation (SD): 13.9]. All the children had consumed iron tablets from their pregnant mothers. Two children presenting with liver failure succumbed to illness. Treatment included a standard protocol of gastric lavage and desferrioxamine. Most of them (3/5) received whole bowel irrigation. We did plasmapheresis in one child who presented with fulminant hepatic failure. The majority were discharged alive (3/5). The presence of coagulopathy, acute liver failure, and delayed presentation were associated with high mortality. Conclusion: Accidental iron poisoning is prevalent in children and associated with significant mortality. Parents and caretakers must be counseled by primary care physicians and made aware of the safe storage of iron tablets. [ABSTRACT FROM AUTHOR]

Setting: Paraquat is a highly toxic, herbicide, extensively used in various parts of India. There is no effective treatment for paraquat poison and carries a very high mortality. In India, this compound can be misused for harmful purposes. Objective: A retrospective time-bound descriptive study of paraquat-consumed patients was conducted at Kasturba Hospital, Manipal, from January 1, 2014 to January 31, 2016. Materials and Methods: All the data were analyzed using the SPSS version 16. All the categorical data are expressed in terms of frequency and percentage. Continuous normal variables were expressed in terms of mean ± standard deviation, and skewed variables were expressed in terms of median and quartiles. Chi-square test was used to find the association between the categorical independent variables across the outcome in survivors, nonsurvivors, and those patients who were discharged from the hospital against medical advice. Similarly, Fisher's exact test was performed for those variables, for which 20% of the expected cell count was <5%. Kruskal--Wallis test was used to compare the relationship between the continuous skewed variables across the outcome. Results: A total of 55 paraquat-consumed patients were admitted, out of which 67.27% (n = 37) of patients were men. Only 32.7% (n = 18) of patients were farmers. Oral ulcers were seen in 43.6% (n = 24) of patients. About 65.5% (n = 36) of patients underwent hemoperfusion, 27.3% (n = 15) of patients survived, 47.3% (n = 26) of patients expired, and 25.5% (n = 14) of patients were discharged against medical advice in a critical condition. The presence of respiratory failure, hypotension, need for ventilator supportive therapy, the elevation of levels of blood urea, serum creatinine, and liver enzymes AST and ALT levels were statistically significant in three groups (P < 0.001). Conclusion: Paraquat poisoning is highly fatal. Treatment is expensive and available only in tertiary care hospitals in India. Central and state governments should ensure that it should not be readily accessible to ordinary people and it should be banned progressively. [ABSTRACT FROM AUTHOR]

Spice consumption, along with other environmental factors, can contribute to pediatric lead poisoning. Although public health efforts have increased awareness of contamination of spices, false assumptions regarding the safety of home-prepared spices have emerged. Here, we present the clinical features, family beliefs, and environmental toxicology of 3 spice-associated pediatric lead poisoning cases. [ABSTRACT FROM AUTHOR]

Background: This research aimed to evaluate the clinico-epidemiological profile and short-term outcomes of patients admitted to the emergency department of a tertiary hospital. Materials and Methods: This prospective observational cross-sectional study was conducted between January 1, 2021, and June 30, 2022, in the Emergency Department of a tertiary hospital. Patients of either gender of any age attending the emergency department with acute poisoning were included. These cases were analyzed for their epidemiological profiles, poisoning characteristics, and various clinical variables influencing patient outcomes. Results: Out of a total of 236 patients, 190 patients (80.5%) were aged more than 18 years. Comorbidities were present in 32 (13.5%) patients, and psychiatric illness was the most common comorbidity. The intention of poisoning was suicidal in 185 patients (78.4%) and accidental in 51 patients (21.6%). Organophosphate was the most common poisoning seen in 55 patients (23.3%), followed by drug ingestion seen in 44 patients (18.6%). Twenty-eight patients (11.8%) were transferred to the intensive care unit. Nineteen patients (8.1%) required mechanical ventilation. There were ten deaths (4.2%) in the study population. Aluminum phosphide poisoning was associated with the highest mortality rate, followed by organophosphate poisoning. Conclusions: This study indicates that most poisoning cases involved young people, mainly males. Organophosphorus poisoning was one of the most common poisonings, followed by the ingestion of drugs in this part of the world. Aluminum phosphide had the highest fatality rate. [ABSTRACT FROM AUTHOR]

Introduction: The WHO 2021 data estimate that 2 million lives and 53 million disability-adjusted life-years were lost in 2019 due to exposures to selected chemicals. It is important to know the pattern and outcome of acute poisoning cases for proper planning, prevention and management. Knowing the pattern will also help in designing training modules for primary care physicians to make them aware about newer poisons and their management. Awareness regarding newer poisons consumed is necessary for early identification, initial management and timely referral to higher centres by primary care physicians. This study was performed to see the pattern and outcome of acute poisoning cases in North Indian population and various factors related to outcome. Materials and Methods: This study was conducted in department of medicine of a teaching institute in North India after approval by the Institutional Review Board. Patients admitted in the department during the study and fulfilling the inclusion criteria were enrolled in the study after obtaining consent. Results: A total of 417 patients with poisoning were recruited in the study. Out of 417 patients, majority were males (59.5%). Maximum number of patients were in the age group of 21-30 years (33.8%), and rural population (79.9%) was found to be more affected. Most of the patients were students and private employees. Most common types of poisoning were snakebite (n = 109, 26.1%), organophosphate (n = 49, 11.8%) and aluminium phosphide (n = 39, 9.3%). Out of 417 patients, 349 (83.69%) improved, while 68 (16.3%) expired. Requirement of ventilatory support was most commonly associated with aluminium phosphide poisoning (30.12%) followed by organophosphate poisoning (24.1%). Conclusion: Poisoning was more common in young males and more prevalent in rural population. Pesticides and snakebite were major causes of poisoning. Among suicidal cases, family conflict (problem/altercation with family members/marital discord) was main reason for the consumption of poison. There is need for creation of poison information centre along with separate toxicological units in tertiary care hospitals. [ABSTRACT FROM AUTHOR]

Background and Objectives: The aim of this was to present our firsthand observations and findings pertaining to the occurrence of acute kidney injury (AKI) subsequent to exposure to toxic substances. Methods: This retrospective study involved the collection of data from patient case records at a prominent nephrology hospital situated in central India. Patient records were carefully examined to obtain information regarding the ingested substance, symptoms observed upon presentation, basic laboratory test results obtained upon admission, the treatment modality employed, and the ultimate outcome. It is important to note that patients who developed AKI following snake envenomation or scorpion stings were specifically excluded from this study. Results: A total of 200 cases involving AKI resulting from poisoning were identified. The largest group within this cohort consisted of patients who were affected by paraphenyline diamine poisoning. Additionally, there were cases of methanol poisoning, organophosphorus compounds, paraquat, and copper sulphate poisoning, tartaric acid poisoning, phenobarbitone poisoning. Notably, 9 patients had ingested a combination of multiple substances. Among the affected patients, 95% required renal replacement therapy. Overall, 70% of patients achieved complete recovery, while 30% succumbed to the acute phase of the illness. Conclusion: The reporting of toxic substances that lead to the failure of vital organs is of utmost importance in order to enhance awareness among the general population and healthcare providers. By providing comprehensive documentation and dissemination of information regarding these substances, the understanding of the potential hazards associated with them can be improved. [ABSTRACT FROM AUTHOR]

Acute methyl alcohol toxicity can lead to severe ocular morbidity. In the present study, we aimed to observe the ocular outcomes in acute methyl alcohol poisoning and determine the biochemical predictors of the final visual outcome. This was a hospital-based descriptive study conducted on 19 consecutive patients of acute methanol poisoning presenting to the Ophthalmology department of a tertiary care multispecialty hospital in Eastern India. Thorough clinical history was obtained in each case. A comprehensive ocular examination was done. Details of systemic treatment provided were obtained in all cases. Nineteen patients were included in the study. All patients were males. The average age of patients was 35.84 ± 9.25 years. All patients complained of bilateral blurring of vision. One patient had severe vision loss with visual acuity of hand movements in both eyes. Colour vision was absent in 7 eyes (18.41%), and impaired in 5 eyes (13.15%). Disc edema was seen in 5 eyes (13.15%). High anion gap metabolic acidosis was seen in 13 (78.9%) cases. Serum bicarbonate level was < 22 mmol L-1 in 13 (68.42%) patients. Eleven (57.89%) patients underwent hemodialysis. The presence of metabolic acidosis, high anion gap, and high base deficit were associated with poor visual acuity and defective color vision both at the initial presentation and final follow-up. Metabolic acidosis, high anion gap, and base deficit at the time of presentation are associated with defective color vision, abnormal pupillary reaction, and poor vision both during initial and final visits. Prompt management of these metabolic abnormalities can decrease ocular morbidity and improve the final visual outcomes. [ABSTRACT FROM AUTHOR]

Background: Arsenic toxicity in humans is well recognized. It has been classified as a class I human carcinogen by the International Agency of Research on Cancer. Arsenic enters the human body mainly through drinking water, dermal contact, food chain, and inhalation. The Gangetic belt of India is considered as one of the most arsenic-affected sites in India. Health risk assessment of the human population exposed to arsenic in drinking water is important. The present study was conducted to assess the groundwater quality and associated health risks on the people of Samastipur district in the middle Gangetic belt of Bihar. Groundwater samples from 40 different study sites were collected and analyzed for various physico-chemical properties of water. Results: Arsenic (> 0.01 mg/L) was present in 33% of the water samples analyzed. Subsequently, an assessment for carcinogenic risk and non-carcinogenic health risk (HQ) for children, females, and males in the study area was performed. Risk assessment showed that 100% of the population may be at carcinogenic health risk and 35% may be at non-carcinogenic health risk, and among these, children were at maximum risk. Furthermore, the computational assessment of the arsenic–protein interactome revealed the enrichment of cancer-related pathways. Conclusions: It is recommended to provide arsenic-free alternate sources of water in the study area. [ABSTRACT FROM AUTHOR]

Organophosphates (OP) poisoning continues to be a major cause of deliberate self-harm and an important cause of morbidity and mortality in India. We aim to study the clinico-epidemiological features in patients presenting with OP poisoning. This prospective observational study involved 400 patients above 18 years of age admitted to the emergency department of a tertiary care institution in Northern India. The study cohort was graded into mild, moderate & severe based on the Peradeniya Organophosphorus Poisoning (POP) scale and degree of cholinesterase inhibition. The majority of patients (40%) in our study population were aged between 18-25 years. There was a significant female preponderance (82% vs. 18%; P=0.000). Suicide was the most common motive (93%) and ingestion was the most common mode of poisoning (99%). The muscarinic and nicotinic symptoms were common at the presentation. Seizures were present in 11% of patients. On the POP severity scale, mild, moderate and severe poisoning was seen at 50%, 35% and 15%, respectively. Cholinesterase inhibition was mild (>2 kU/L) in 31%, moderate (1-2 kU/L) in 46% and severe (<1 kU/L) in 23%. A total of 48% of patients had complications. Ventilator support was needed in 43% of the patients. An overall mortality of 18% was observed in the study. OP poisoning is a serious public health problem, but timely intervention may help to reduce morbidity and mortality, especially in a resource- limited country like India. [ABSTRACT FROM AUTHOR]

OBJECTIVES: The prognosis of acute aluminum phosphide poisoning is usually based on toxidrome features, with little focus on poison-related factors. We aimed to study the prognostic significance of poison-related factors, consumption patterns, and time delays to treatment. METHODS: We performed a prospective cohort study in an academic hospital in North India in patients aged = 13 with aluminum phosphide poisoning from July 2019 to December 2020. During data collection, a particular emphasis was made on the poison formulation, the ingested dose, the reconstitution of poison, vomiting, and time intervals to initiate various treatments. The primary outcome was inhospital mortality. RESULTS: Fifty-eight patients were enrolled (median age, 32 years; 37 males). The mean dose of the ingested poison was 6.56 (±5.42) g. The predominant formulation of poison was pellet (n = 41), followed by powder (n = 16). Twenty patients performed reconstitution of poison before consumption, and 13 stirred the poison while reconstituting. All patients but three developed vomiting after consumption. Inhospital mortality (n = 23, 39%) was significantly high with a higher ingested dose (P < 0.001), nonstirred reconstitution before consumption (P = 0.042), fewer vomiting episodes (P = 0.010), a delay in detection of the victim by someone (P = 0.001), and delayed initiation of intravenous fluids (P = 0.043). The secondary outcomes (shock and requirement of vasopressor or ventilation) remained unaffected by the stirring in the reconstitution group. CONCLUSIONS: Poison-related factors and time intervals determine early risk stratification at admission in aluminum phosphide poisoning. [ABSTRACT FROM AUTHOR]

Background: Organophosphorus compounds are widely used as pesticides in agriculture practicing countries like India. Since it is readily available and accessible, it is one of the most commonly used agents for suicidal poisoning. The current study was undertaken to evaluate the performance of the SOFA score (scoring system) and the serum lactate level (laboratory parameter) as a mortality predictor in organophosphorus poisoning. Material and Methods: This prospective observational study was conducted at AIIMS, Bhubaneswar, for 17 months. The study population included all patients with an alleged history of ingestion of organophosphorus (OP) compounds reporting to the casualty. The receiver operating characteristic (ROC) curve and the logistic regression analysis were used for the analysis. Results: In our study, 75 patients with OP poisoning were studied after satisfying the inclusion criteria. OP poisoning was commonly seen in married males aged 21–40 years. Twelve (16%) patients died during the process of treatment. There was a statistically significant difference in the mean SOFA score, serum lactate level, pH value, and mean duration of hospital stay between the discharged and the deceased patients. In the current study, the ROC curve analysis used to assess the predictor of the outcome of OP poisoning showed that the area under the curve for SOFA score and serum lactate level were 0.794 (95% CI 0.641–0.948) and 0.659 (95% CI 0.472–0.847), respectively. Conclusion: Sequential Organ Failure Assessment (SOFA) score is significantly associated with the outcome of organophosphate poisoning and can be utilized to predict mortality. [ABSTRACT FROM AUTHOR]

Background: Poisoning is an important health hazard and one of the leading causes of morbidity and mortality worldwide including in India. The study was conducted to understand the magnitude, pattern, and gender differentials of all poisoning fatalities in relation to the manner of death autopsied at a tertiary care center. Methods: A retrospective study of all fatal poisoning cases autopsied at the department of Forensic Medicine & Toxicology of a tertiary care institute in Northern India for the period 1st January 1998 to 31st December 2017 was conducted, and a profile of the victims of fatal poisoning was prepared. Data were analyzed with descriptive and inferential statistics. Results: The study included a total of 1099 cases of fatal poisoning autopsied at the department of Forensic medicine & Toxicology. Suicidal poisoning was reported in 90.2% of cases and accidental poisoning was seen in 8.9% of cases. Males were predominantly affected (63.8%). The majority of the victims were in the 3rd decade (40.0%) of life. The age of the victims ranged from 2 to 82 years with a mean age of 38.4 years. Agrochemical compounds were implicated in 44.4% of the total fatalities. Conclusion: Males in the 2nd to 4th decades of life were more prone to self‑poisoning with Agrochemical compounds in the region of North India. Accidental poisoning deaths were uncommon and poisoning was not a preferred method of homicide in this region. Our approach to the study reveals that quantitative chemical (toxicological) analysis is required to further strengthen and improve the databases of the epidemiology of poisoning in this region. [ABSTRACT FROM AUTHOR]

Background: This prospective study aimed to assess the clinical and demographic profile of adolescent poisoning cases admitted to the Department of Pediatrics at HIMS Hassan, India. Methods: A total of 105 patients aged between 10 and 17 years were included in the study, with data collected regarding their clinical-demographic profile and consumption details. Results: The majority of cases were female (79%) and from a rural area (63.8%). In terms of socioeconomic status, the largest proportion of cases were from the upper lower class (32.3%). Insecticide (26.6%), rat paste (13.3%), acid (11.4%), and tablet consumption (24.7%) were the most common poisons consumed by the adolescents. Suicidal consumption accounted for 85.7% of cases, while 14.2% were accidental. Regarding treatment, 80% of patients received supportive and symptomatic management, while 20% received a specific antidote. Conclusion: The study provides valuable information about the clinical and demographic profile of adolescent poisoning cases in India, which can be used to inform prevention and management strategies. [ABSTRACT FROM AUTHOR]

Introduction: Death due to acute poisoning is one of the most vital health challenges to cope-up. It is very essential to have a better understanding regarding the patterns of these deaths in order to prepare the relevant remedies for the same. Aim: The aim of the present study is to assess the patterns of deaths due to poisoning in a tertiary care center and to study the autopsy related findings of these deaths. Materials and Method: It is an autopsy based retrospective study conducted in a tertiary care center. The ethical clearance was obtained from the institutional ethical committee. Descriptive statistics to study the distribution of the cases among different age groups, sex, type of poison compounds was computed and analyzed using SPSS software version 20 Results: A total of 206 cases were recorded and maximum number of cases were done in 2018. Maximum patients were youngsters in the age group of 21-30 years (36.9%). Males dominated the study (62.6%). 95.1% were living in the rural areas and 62% of the cases belonged from lower socio-economic status. Majority of the patients were hospitalized (52.4%). Almost all the bodies (98.9%) of the dead bodies were fresh and cyanosed. Congested gastric mucosa was seen in 80.9% of the cases. In majority of the cases, the poisonous compound seen was aluminum phosphide (69.4%). Suicidal tendencies contributed to majority of the cases (87.4%). Conclusion: The findings imply that recommendations for the proper handling, storage, and transportation of poisonous compounds should be defined while taking into account the groups of young teenagers without considering their sexual orientation. To manage poisoning cases, it is important to keep in mind that the most recommended agent in acute poisoning is the organophosphate. [ABSTRACT FROM AUTHOR]

Objectives: Lead investigators in North Carolina found evidence that contaminated spices may contribute to children's elevated blood lead levels. We compared lead levels in samples of spices and other consumable products by country of purchase to inform consumer safety interventions and regulations. Methods: From February 1, 2011, through October 22, 2020, North Carolina lead investigators sampled spices and other consumable products from 103 homes of children with confirmed elevated blood lead levels. In 2017, the study team purchased 50 products frequently sampled during lead investigations, as a "market basket" sample, from local stores in or near Raleigh, North Carolina. The State Laboratory of Public Health analyzed 423 product samples using mass spectrometry. We extracted environmental sample results from lead investigations from the North Carolina Electronic Lead Surveillance System. Results: The median market basket lead result was 0.07 mg/kg (SD = 0.17); the maximum lead result was 0.88 mg/kg. The median home lead investigation sample result was 0.26 mg/kg (SD = 489.44); the maximum lead result was 6504.00 mg/kg in turmeric purchased in India. Among all samples, products purchased in India had more than triple the median lead levels (0.71 mg/kg) of those purchased in the United States (0.19 mg/kg). Conclusions: Purchasing spices in the United States is an action that consumers can take that may reduce their lead poisoning risk. Regulatory agencies should consider a lead limit of <1 mg/kg as attainable for spices sold in US stores and for ingredients of any foods that may be consumed by children. [ABSTRACT FROM AUTHOR]

An estimated 70 million population are exposed to arsenic poisoning in India in the 2020. The present study is aimed to develop the antidote for arsenic-induced toxicity in Charles Foster rats. A total of n=18 rats (12 weeks old) of an average weight of 160 ± 20 g were used for the study. The study group included three groups, n=6 control (Group I: Untreated) and n= 12 (group II) treated with sodium arsenite orally at the dose of 8mg/Kg b.w daily for 6 months. The n= 6 animals were dissected and the rest n=6 (Group III) was administered orally with Panax quinquefolius (Ginseng) root ethanolic extract at 300mg/Kg body weight per day for 8 weeks. All the animals were sacrificed after the completion of their respective doses and their blood samples were taken for haematological and biochemical evaluation, while the vital tissues such as liver and kidneys for the histopathological study. The study revealed significant fluctuation (p<0.0001/p<0.001/p<0.05) in the haematological parameters viz. leukocyte count, haemoglobin, red blood cell count, haematocrit percentage, MCV, MCH and MCHC and biochemical parameters such as SGPT, SGOT, ALP, bilirubin, urea, uric acid, creatinine and lipid peroxidation in arsenic-treated groups. There was a significant reduction (p<0.0001/p<0.001/p<0.05) in the levels of haematological and biochemical parameters after the administration of ginseng extract. Similarly, the histopathological study revealed a high magnitude of degeneration in the hepatocytes and nephrocytes after the treatment of arsenic, but after the administration of ginseng extract, there was significant restoration at the cellular level. Thus, the root extract of P. quinquefolius possessed significant ameliorative properties against arsenic-induced toxicity in rats. [ABSTRACT FROM AUTHOR]

Poisoning is a very common way to commit suicide. It is more common in low- and middle-income countries. Aluminium phosphide is a very commonly available pesticide in such countries including India. Aluminium phosphide is a very toxic compound. Ingestion of aluminium phosphide can cause severe toxicity to various cells, and mortality is very high. We are presenting a case of rare survival of acute aluminium phosphide poisoning, who presented with signs and symptoms of severe toxicity including metabolic acidosis and shock. During hospitalisation, he developed ventricular tachycardia, acute kidney, and liver failure. [ABSTRACT FROM AUTHOR]

Organophosphorus compounds (OPC) are major components of pesticides and nerve gas agents. Self-harm by ingestion of OPC pesticides is one of the common problems encountered in the emergency room (ER), especially in developing countries such as India. It is recognised by the World Health Organization (WHO) as the third most prevalent means of suicide. In addition to the cholinergic effects caused by these agents, they can induce metabolic dysregulations. We present a case of a 22-year-old male patient, without previous history of diabetes, who was brought to the ER in an unresponsive state with an HbA1c of 5%. His initial laboratory investigations revealed hyperglycemia, high anion gap metabolic acidosis, ketonuria, and glycosuria. His relatives revealed intentional ingestion of OPC. He was treated for both OPC poisoning and hyperglycemic ketoacidosis. Adequate acute care was instigated though prognosis could not be gauged due to the early discharge of the patient against medical advice. This case highlights that OPC poisoning can be a possible etiological factor for hyperglycemic ketoacidosis. It can mimic diabetic ketoacidosis leading to delayed diagnosis. Thus, early identification and immediate management are crucial because of the effect of hyperglycemic ketoacidosis on the outcome of a patient with OPC poisoning. [ABSTRACT FROM AUTHOR]

Organophosphate (op) poisoning is a common poisoning in India with suicidal and accidental ingestion. It is associated with high morbidity and mortality. We present 23 year old male with history of OP poisoning who developed intermediate syndrome with polyneuropathy. Patient managed conservatively along with multidisciplinary team approach leading to a successful management. [ABSTRACT FROM AUTHOR]

The aim of this study was to investigate the sociodemographic characteristics of patients based on the poison chosen and different types of organophosphorus compounds. The data were collected to explore the sociodemographic characteristics of organophosphate (OP)-poisoned patients based on the source, site, and route of poisoning, education level, occupational status, and the purpose of poisoning. Furthermore, we estimated the serotonin and dopamine levels in the plasma samples of patients, and survival plots were also described. During the study of OP pesticide poisoning in 116 human subjects and 5 healthy volunteers, we observed, based on the survival plot, that75.9% of the patients were discharged, and the remaining patients died (24.1% of the patients) due to respiratory failure followed by cardiac arrest. Our findings suggest that the serotonin levels significantly (p < 0.01 and p < 0.001) decreased from 12 to 36 h, whereas the dopamine levels slightly increased from 12 to 36 h in the group with OP poisoning compared to the control group. Based on these findings, this study may aid in deciphering the precise mechanism by which pesticides cause behavioural changes that influence serotonin and dopamine levels in OP-poisoned patients. The purpose of this work was to serve as a small reminder of the risk to public health associated with organophosphate pesticides. [ABSTRACT FROM AUTHOR]

OBJECTIVES: Evaluating local trends and continued monitoring of patterns of acute poisoning are essential for prompt recognition of the toxidromes, the establishment of immediate treatment facilities (e.g., antidote availability), and effective preventive strategies (e.g., governmental regulation on hazardous substances marketing). We aimed to describe the prevalence of the various types of poisoning and associated case fatality in our academic hospital in North India. METHODS: A prospective observational descriptive study was conducted, enrolling patients aged ≥13 years with acute poisoning for 17 months from December 2016 to December 2017 and from September 2019 to December 2019, for a total of 17 months. RESULTS: Four hundred and two patients were enrolled (median age 28 years; 63.2% males). Majority of the acute poisoning cases resulted from ingestion (n = 391, 97.3%) and the primary intention was most commonly self-harm (n = 314, 78.1%). The major types of poisoning were pesticide (n = 264, 65.7%), drug overdose (n = 77, 19.2%), and corrosive ingestion (n = 31, 7.7%). Pesticides included insecticides (n = 146, 36.3%; cholinesterase inhibitors, n = 91), fungicides (n = 76, 18.9%; all aluminum phosphide), herbicides (n = 22, 5.5%; paraquat, n = 19), and rodenticides (n = 20, 5.0%; coumarin-derived substances, n = 12). Benzodiazepines (n = 33) and opioids (n = 25) were frequent causes of drug overdose. 95.3% (n = 379) received preliminary treatment at the previous health-care center, including gastric lavage (n = 239) and antidotes (n = 73). In-hospital case fatality rate was 17.3% (n = 58). CONCLUSION: Herbicide ingestion and opioid overdose are emerging threats with a gradual decline in organophosphate and aluminum phosphide poisoning. Despite improving management of acute poisoning, the overall case fatality rate remains substantial. [ABSTRACT FROM AUTHOR]

In the rural areas of India, most of the poor villagers reared small ruminants, sheep (Ovis aries) and goats (Capra hircus) for the purpose of continuous domestic income. In the villages, the principal drinking water sources are hand-pumps, open-wells, and bore-wells. Water of almost all these sources is contaminated with fluoride (F) and most of them contain F beyond the threshold level (1.0 or 1.5 ppm). But due to the lack of other sources of drinking water, people also feed these domesticated animals with water from these sources. By drinking this water repeatedly over a long period of time, many types of deformities are born in the teeth and bones of these small ruminants. Due to which their teeth become weak, they start breaking and falling, the same animals start walking with a limp. These deformities are referred as dental and skeletal fluorosis, respectively. At the initial level of chronic F toxicosis, the most common health problems, gastro-intestinal discomforts, body weakness, polydipsia, polyuria, repeated abortion, etc. are also found in these ruminants. At the F range, 1.5-4.4 ppm, in drinking waters, the highest prevalence of dental and skeletal fluorosis in sheep and goats was found to be 28.3% and 25.7% and 32.9% and 29.1%, respectively. In rural and remote areas, certain industries and human activities are also potential sources of chronic F toxicosis in these flock animals. In India, 8.33% incidence of industrial fluorosis has been found in goat flocks due to industrial F exposure. The toxicity of F has a profound effect on the health of sheep and goats and their offspring, due to which the income from them is also affected, which is focused on in the present communication besides the brief and critical review of chronic F toxicosis, resistance to F toxicity, and prevention and control of fluorosis in these small ruminants. Findings of this review may useful in making and implementing a health program for the saving of health in these flock animals from chronic F poisoning or fluorosis in the rural areas of the country. [ABSTRACT FROM AUTHOR]

Introduction: According to data available from National Poison Information Centre India, suicidal poisoning with household agents (organophosphates, carbamates etc.,) is the most common modality of poisoning. There are reports suggesting relationship between prolonged corrected QT interval and the severity of Organophosphate (OP) poisoning. Corrected QT (QTc) interval is measured in 12 lead electrocardiograms taken on admission. Aim: To assess prognosis of acute organophosphate poisoning patients by studying association of corrected QT interval with its complications and mortality. Materials and Methods: The present cohort study was conducted at Medicine Department of Medical College, Baroda and Sir Sayaji General Hospital, Vadodara, Gujarat, India, from December 2017 to November 2018. The study included 60 patients with a history of OP poisoning. The QTc interval in electrocardiogram was determined by using the Bazett formula. Prognostic importance of QTc interval was assessed by correlating it with Paradeniya Organophosphorus Poisoning Scale score, hospital stay, atropine requirement, requirement of ventilatory support and mortality. Data was analysed by using descriptive statistics and Chi-square test. Results: The organophosphate poisoning was seen more in younger age group, between 18-29 years (68.4%). The QTc prolongation was seen in 12 (80%) of patients in moderate grade of Paradeniya Organophosphorus Poisoning Scale and in 9 (20%) patients among mild grade of Paradeniya Organophosphorus Poisoning Scale (p-value=0.0001). Amongst patients who needed hospital stay for more than seven days, QTc prolongation was seen in 43% of patients, and in patients who needed hospital stay for less than seven days QTc prolongation was seen in 9% of patients (p-value=0.0223). Statistically significant association was seen between atropine ampule requirement and QTc prolongation. Total 29 (48.3%) patients developed respiratory depression, and amongst them 19 (65.5%) had QTc prongation (p-value <0.0001). Out of, 13 (22%) patients died and amongst them 12 (92.31%) had QTc prolngation. In those who survived 47 (78%) only 9 (19.15%) had QTc prolongation (p-value <0.0001). Conclusion: Prolonged QTc interval in electrocardiogram is a good prognostic indicator in patients with organophosphorus poisoning. Early identification of prolonged QTc interval and subsequent timely shifting of patients to Intensive Care Unit (ICU) and subsequent intensive management in a patient of OP poisoning would be of profound value at any level of health care setting for favourable outcomes. [ABSTRACT FROM AUTHOR]

Background: Acute poisoning is a common cause for morbidity and mortality in children. The profile and outcome in children with acute poisoning depend a lot on the socioeconomic status, cultural practices, parental education status, and availability of health care. The present study was aimed to analyze the pattern and outcome of pediatric poisoning in rural area. Methodology: This is a retrospective study conducted over a period of twenty-four months in a rural hospital attached to medical college. Results: The poisoning constituted 4.7% of total admissions in Pediatric Intensive Care Unit (PICU). Male: Female ratio was 1.33. 98(87.5%) of children were less than 5 years of age. Organophosphorus compounds were most commonly (n = 55, 49.1%), responsible for poisoning, followed by kerosene (n = 20, 17.9%). Thirty percent children had short stay in hospital i.e., less than 48 hours. Overall survival rate noted in the study was 91% (n=103). Conclusion: Poisoning in Pediatric age contributes to significant number of admissions to Pediatric Intensive Care Unit in rural area. Insecticide/Pesticides, Kerosene, and plants were leading causes of poisoning. [ABSTRACT FROM AUTHOR]

Arsenic contamination of water is now a global problem. More than 100 countries, including India, are facing the problem of a high level of arsenic in the groundwater. There is a wide range of negative impacts of arsenic contamination on society and the economy, threatening sustainability in the contaminated areas. To examine the magnitude and effects of arsenic in the Shahpur block of the Bhojpur district, Bihar, India, we tested groundwater samples from many different locations. Household surveys and personal interviews were conducted to find out the societal response to this problem. Sample testing results confirm a high rate of arsenic contamination in the area. Our study found that; the low education level of the area is hampering the sustainable solution to the problem. We came to know that people who are suffering from arsenic diseases are discriminated against the society. Further, we have also found that the economic burdens of arsenic contamination are more on the marginalized section of the community. Since crops are irrigated with high arsenic concentrated water, soil quality is degrading, responsible for poor agriculture output and economic loss. It has also been found that most of the mitigation measures employed are not sustainable in the long term. Awareness regarding arsenic toxicity is needed for the sustainable intervention of this problem. After examining all the mitigation measures, we concluded that rainwater harvesting and rooftop rain harvesting is the most sustainable and cost-effective measure to tackle this menace. [ABSTRACT FROM AUTHOR]

Background: Paraquat is a herbicide commonly used for controlling weeds in India. The primary target organs for paraquat poisoning are the lungs and the kidneys. Acute cases of poisoning with paraquat are admitted to the hospital with various stages of acute kidney injury. Aim: To study the clinical presentation and outcome of paraquat poisoning in a tertiary care setting. Materials and Methods: A retrospective observational study was conducted at SDM College of Medical Sciences and Hospital, Dharwad. In this study we included the data of all patients admitted to the hospital with paraquat poisoning for a period of three-year and four months between January 2018 to April 2021. Results: A total of 12 participants were included in the final analysis. All the patients consumed paraquat with the suicidal intention only. The quantity of paraquat ingested was quite varied, ranging from as low as 5ml to as high as 200ml. Acute Kidney Injury (AKI) was diagnosed in 58.3% of patients. Among which three patients were in stage 1, one was in stage 2, and three were in stage 3. The mortality rate was 58.33%. The major cause of death for these patients was multiple organ dysfunction syndromes (71.42 %). Conclusion: Acute kidney injury is the major clinical outcome of paraquat poisoning other than lung injury. This may result in multiple organ dysfunction syndrome (MODS) and mortality. Paraquat poisoning is due to consumption with suicidal intent. Most of them were young. Early management with hemoperfusion may have a positive effect on reducing mortality. [ABSTRACT FROM AUTHOR]

Background: Salmonella enterica, serotype typhi, remains the predominant Salmonella species causing enteric fever in India. The mode of Salmonella typhi transmission is considered to be predominantly vehicle-borne through contaminated water or food. In India, the incidence of Salmonella typhi occurs between the months of April and June (dry season) followed by July and September (monsoon season). Typhoid fever may be difficult to distinguish clinically from other febrile illnesses and if left untreated, intestinal, neuropsychiatric, and other complications develop in some patients. Objective: The aim of this study was to determine the prevalence of S. typhi in bloodstream infections and its antimicrobial susceptibility pattern among patients with febrile illness. Methodology: Febrile patients admitted in the hospital who were prescribed blood culture tests and whose samples were sent to microbiology laboratory were included in the study. All blood samples (average 5 mL for adults and 2–3 mL for pediatric age group) were immediately inoculated into Bac-T ALERT aerobic blood culture bottles containing sodium polyethanol sulfonate as an anticoagulant (0.025%). If growth was isolated, isolated colony characteristics of growth and Gram stain were assessed. On Gram staining, typical nonlactose fermenting Gram negative bacilli were further subjected to species identification and detection of antimicrobial susceptibility pattern on the VITEK2. Results: In this study period, a total of 511 blood culture (paired) samples were processed, out of which 47 isolates of Salmonella were obtained. Among these isolates, 33 (70.23%) were from males, and 14 (29.77%) were from females. Amongst these, 35 (74.4%) patients were from rural, 8 (17%) were from subrural, and 4 (8.5%) were from urban areas. Out of the total 47 isolates of Salmonella, 42 (89.36%) were Salmonella typhi, 2 (4.25%) were Salmonella paratyphi A and B each, and 1 (2.12%) was Salmonella enterica. Antimicrobial susceptibility pattern of Salmonella isolates revealed that all the isolates of Salmonella species were highly susceptible (95%–100%) to third generation cephalosporins (ceftazidime, ceftriaxone, cefepime, cefoperazone-sulbactam) and other higher antibiotics such as betalactamase inhibitors – piperacillin tazobactam (95%–100%) and Ticarcillin–clavulanic acid (100%). They were also highly susceptible (100%) to carbapenams (imipenem, merpenem, doripenem, and ertapenem) but showed a fairly decreased susceptibility was towards nalidixic acid with 15% for Salmonella typhi and 50% for other Salmonella isolates. Conclusion: Surging drug-resistant Salmonella enterica cases, the level of resistance was not as high as predicted in our study population. Multidrug-resistant (MDR) trends may vary; therefore, drug susceptibility testing side-by-side to empirical therapy is mandatory, especially in developing countries where there is a practice of self-medication. [ABSTRACT FROM AUTHOR]

Lead exposure in India is common in industries that may present with nonspecific signs and symptoms or symptoms of toxicity, depending on the amount of lead absorbed. We are presenting two case reports of occupational lead exposure in a lead-based battery manufacturing unit, which were presented as intestinal obstruction. Both the patients aged 28 and 24-year old presented with complaints of pain in the abdomen with blood lead levels of 61.1 and 85 μg/dl, respectively. The diagnosis was made clinically before any other radiological investigation or intervention. Both the patients were treated conservatively with D-Penicillamine, following which, both the patients improved symptomatically and the blood lead level also decreased. The importance of a detailed history of occupation & clinically diagnosing such patient will avoid unnecessary investigation and intervention. This will help to reach the correct diagnosis in such cases. [ABSTRACT FROM AUTHOR]

Introduction: Organophosphate Poisoning (OP) is very common in India and presents with features of cholinergic excess. Timely diagnosis and prompt treatment helps in prevention of complications like aspiration pneumonitis, respiratory failure etc. Due to non availability of Pseudo cholinesterase measuring facility at many rural areas and subcentres and as hyperglycaemia, glycosuria and ketonuria are commonly seen in OP poisoning, the study of association of these three parameters with OP poisoning is of utmost importance. Aim: To study the association of hyperglycaemia, glycosuria and ketonuria with severity of OP. Materials and Methods: This was a cross-sectional study with a sample size of 120 patients of OP poisoning, who reported to Karnataka Institute of Medical Sciences Hospital, Hubli, from December 2017 to November 2018. Adults >18 years of age with OP poisoning with no pre-existing diabetes were included. Clinical features with Peradeniya Organophosphate Score (POP Score), Complete Blood Count (CBC), Pseudo cholinesterase level, serum amylase, Gylcated Haemoglobin (HbA1c), Random Blood Sugar (RBS), urine ketones, urine glucose levels were obtained. The data was analysed using Chi-square test, Analysis of Variance (ANOVA), paired t-test, Pearson's and Spearman's correlation test. Results: Majority of the study population belonged to age group of 20-40 years (57.5%). Mean RBS at presentation was 200.58±110.31 mg/dL. Mortality was associated with higher RBS at presentation and RBS after 12 hours. There was significant association between RBS and outcome. Increasing RBS levels had direct correlation with mean duration of Artificial Manual Breathing Unit (AMBU) ventilation, mechanical ventilation, ICU stay duration, hospital stay duration and mortality rate. Deaths in cases with RBS <150 mg/dL was 2 and in >250 mg/dL is 22. Among the study population, eight cases had glycosuria and six had ketonuria at presentation. Mean POP score was also higher among these subjects with hyperglycaemia, glycosuria and ketonuria. Conclusion: Blood sugar levels, urine analysis for glucose and ketones are useful, simple and cheap markers for identifying the severity of OP. Their presence indicates patient was at higher risk of developing complications and patient may be planned for referral to higher centre from non equipped centres. Hyperglycaemic state is a poor prognosticating factor. [ABSTRACT FROM AUTHOR]

Introduction: Mushroom poisoning occurs from consumption of the wild variants of mushroom containing varied forms of toxins. Among those toxins, amatoxin containing mushrooms are known for the significant morbidity and mortality from hepatic toxicity and delayed gastroenteritis. Although not a very common cause of poisoning, it is prevalent in the north-eastern region of India, especially during the rainy summer seasons when the wild variants are found abundantly and often confused with the edible variants. Aims and Objectives: To study the clinical and biochemical profiles and short term outcomes of patients with mushroom poisoning admitted to a tertiary care hospital. Materials and Methods: We analyzed the data of patients with mushroom poisoning admitted to a tertiary care institute in north-eastern India between January 2015 to December 2020 to study their clinical and biochemical profiles, and short-term outcomes. Their clinical features, biochemical parameters, management, and in-hospital outcomes were noted. All data was recorded in Microsoft MS Excel and analyses done using SPSS version 22. Results: Of the 44 patients with mushroom poisoning, 23 (52%) were male and 21 (47%) were female, with a mean age of 20.13 years. Seventeen patients (38%) had delayed liver failure and delayed gastroenteritis, 19 patients (43%) had acute gastroenteritis syndrome, 5 patients (11%) had cholinergic symptoms, one patient (2%) each had acute kidney injury and a disulfiram-type reaction with headache. The mean hospital stay of the patients was 5 days. In-hospital mortality occurred in 10 (58%) patients with delayed liver failure and none of the patients with the other complications died. Conclusion: This study revealed a high prevalence of mushroom poisoning that caused delayed liver toxicity and delayed gastroenteritis, probably amatoxin-induced, which is fatal, thus accounting for high mortality and poor outcomes in these patients. [ABSTRACT FROM AUTHOR]