Background: Corrosive substances are common household substances that can be ingested either accidentally or intentionally with suicidal intent. The present study was conducted to analyse the clinical profile of 50 cases of corrosive injury of GI tract and to analyse the outcome of 50 cases of corrosive injury of GI tract.Methods: The Cross-sectional study was conducted on 50 cases admitted in the toxicology ward in Rajiv Gandhi Government General Hospital, madras medical college, Chennai over a period of six months. Patients with history of corrosive ingestion presenting within 24 hours of ingestion subjected to Upper GI endoscopy within 24 hours of admission. Patients presenting after 24 hours, with respiratory distress, suspected perforation either radiologically clinically and normal findings in Upper GI endoscopy were excluded. The patients were serially followed and were subjected for a re-look upper GI endoscopy after 6 weeks and the findings were compared.Results: Corrosive ingestion was more common in the age group 20-30 years and more common in males. Acid ingestion was almost twice as common as alkali ingestion. Suicidal ingestion was the most common circumstance of consumption and associated with higher grade of injury. Patients with ingestion of more than 50 ml had higher grades of injury and also were at higher risk of strictures. The spectrum of injury to the GI tract revealed esophageal injury of grade II b to be the most common finding with the duodenum being spared in majority of the cases.Conclusions: In our study, Patients with ingestion of more than 50ml had higher grades of injury and also were at higher risk of strictures. While the lesser grade injuries (0, I, IIa) were associated with complete recovery with no sequelae, the more severe grades (IIb and IIIa) were associated with higher incidence of strictures especially the circumferential lesions. Oesophageal strictures are commonly associated with suicidal corrosive ingestion. All patients with corrosive ingestion should be subjected to early UGIE and after 6 weeks to identify stricture formation.
Background and Objectives Omicron, a variant of SARS COV2, is looming large as a cause of global concern. Its high transmissibility can pose challenges in healthcare allocation in a highly populous country like India. Studying the behaviour of the virus among the Indian population will definitely help in planning for the impending omicron surge, so we conducted a preliminary analysis of the clinical and epidemiological characteristics of the suspected omicron cases in the early part of the surge. Methodology The study was conducted in the Rajiv Gandhi Government General Hospital, from 17th December 2021 to 11th January 2022. A total number of 159 consecutive patients ≥18 years of age with the S gene target failure were enrolled and clinically followed up during hospitalisation. Results Nearly half (n = 79, 49.7%) were aged between 18 and 30 years and the mean (SD) age of the patients was 35.1 (14.9); 52.8% (n = 84) were males and 54.7% (n = 87) were healthcare workers. The NLR ratio and CRP were raised in unvaccinated individuals. Out of 159 patients, only 4 patients required oxygen and all the others showed a mild course of illness and there was no mortality. Conclusion The clinical course of suspected omicron patients was mild in those who were vaccinated. Unvaccinated individuals with comorbid illness need to be closely monitored for prompt referral for acute care. Further studies are needed in the high-risk group with omicron.
Background: Type 2 diabetes mellitus (T2DM) is one of the major global public health concerns, metformin is one of the most widely used drugs and considered as first-line therapy for management of T2DM. Vitamin B12 malabsorption is observed in patients on metformin therapy leading to biochemical and clinical vitamin B12 deficiency. The aim of the current study was to assess the relationship between metformin therapy and development of vitamin B12 deficiency.Methods: Current observational cross sectional study was conducted at Madras medical college and Rajiv Gandhi Government general hospital. Serum vitamin B12 and other blood investigation parameters of T2DM patients, on metformin therapy for long duration (6 months or more than 2 years) were measured and correlated with vitamin B12 levels of T2DM patients not on metformin therapy. Patients were given appropriate treatment and were regularly followed up.Results: Results of the current study findings depicted that significant difference was observed in percent haemoglobin, total blood cells, platelet count, mean corpuscular volume (MCV) and albumin values of patients on metformin therapy when compared to patients who were not on metformin therapy. Study findings also revealed that substantial difference in vitamin B12 deficiency was observed in T2DM patients based on the duration of metformin therapy.Conclusions: Current study revealed that, metformin therapy for 2 years or more, can lead to significant vitamin B12 deficiency which is also associated with macrocytosis. It was concluded that longer the duration of metformin therapy, more significant would be vitamin B12 deficiency.
Background: Deaths by acute organ phosphorus poisoning is very common in rural India especially in people associated with agriculture sector. The present study was aimed to study the clinical characteristics of organ phosphorus compound (OPC) poisoning and to assess the associated factors related to the outcome (recovery/death) of intermediate syndrome (IMS). Methods: This is an observational study conducted on 40 patients showing features of intermediate syndrome at Poison center, Institute of internal medicine, Rajiv Gandhi Government General Hospital, Chennai. Detailed clinical examination was done on the day of admission and daily with close monitoring. All patients included under study will be treated with pralidoxime as per protocol, atropine as required and other supportive measures was provided. Mechanical ventilatory support was provided for patients in respiratory failure. Patients are followed up till the end point of outcome (recovered and discharged/death) that was correlated with type of compound, quantum of exposure, duration of IMS, serum cholinesterase and creatinine kinase levels and respiratory failure. Results: Patients of age group between 30-40 years are more affected. Males outnumbered the females and most of them are from agriculture sector (65%). Out of 40, on treatment and follow up 34 patients were recovered and 6 were died. Onset of intermediate syndrome ranges between days 2-4 following exposure and duration of symptoms was observed for 5-16 days. Methylparathion was the frequent compound associated with IMS in about 9 cases. Out of 40, 16 had respiratory failure and given ventilator support. Proximal muscle weakness was seen in about 38 patients as common symptom. Conclusions:The results of the present study concludes that factors such as mode of poisoning, onset of IMS, type of compound, PChE level are not correlated with the outcome of study. Duration of IMS, respiratory failure, ventilator associated pneumonia (VAP), ventilator support duration were associated with outcome of the study. Hence, early recognition of IMS and its associated respiratory paralysis is very important in patients affected with OPC toxicity to prevent morbidity and mortality rate.
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