Impact of lockdown on medical emergency visits during the COVID-19 pandemic in India

Saini, Mandeep Kaur; Kumar, Hemendra; Saini, Komal; Behera, Ashish; Pannu, Ashok Kumar; Kathirvel, Soundappan; Kumar, Mohan

doi:10.1136/postgradmedj-2021-140850

Cited by 8 publications

(7 citation statements)

References 5 publications

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“…[ 14 15 16 27 ] The inhospital mortality was 39% in our study, with a mean ingested dose of 6.5 g. In contrast, in previous studies, the ingested dose varied from 1.2 to 5.1 g, with a mortality rate ranging from 30% to 60%. [ 9 18 26 29 ] The reason for this discrepancy may be multifactorial such as consumption of expired formulations that exert lesser toxicity, differences in the method of consumption, including reconstitution, and early institution of treatment. The dose taken into consideration in our study is the actual dose of formulation consumed by the patients.…”

Section: Discussionmentioning

confidence: 99%

“…In contrast, the previous studies have either considered the effective dose of toxin or did not mention the toxin or formulation. [ 9 18 26 29 ] Although government protocols have dictated standardization of tablet and granulation formulations into 3 and 10 g, their easy accessibility to the general public makes aluminum phosphide a typical “suicide poison.”[ 6 ] More steps need to be taken to reduce the dose of formulations available in the market and restrict their availability to select groups.…”

Section: Discussionmentioning

confidence: 99%

“…About 100–120 patients are admitted daily to the ED of this 1948-bedded hospital from a large population of North India. [ 25 26 ] The age criterion for admission to our adult medical emergency is ≥13 years. The institutional ethics committee approved the study (No.…”

Section: Methodsmentioning

confidence: 99%

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Prognostic significance of poison-related factors and consumption patterns in acute aluminum phosphide poisoning

et al. 2023

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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.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Prognostic significance of poison-related factors and consumption patterns in acute aluminum phosphide poisoning

et al. 2023

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“…[ 19 ] About 100–120 are admitted to ED, and toxicological emergencies constitute 1–2 cases per day. [ 19 20 ] The age criteria for admission to our adult medical emergency is ≥13 years. Our study combines two prospectively collected data from December 2016 to December 2017 and from September 2019 to December 2019 (17 months).…”

Section: Methodsmentioning

confidence: 99%

Changing spectrum of acute poisoning in North India

Pannu

Bhalla

Vamshi

et al. 2022

Turkish Journal of Emergency Medicine

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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.

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“…Among other things, the effects of the pandemic on emergency interventions are being researched. Only some of them are cited in this work: Andrew et al, 2021, Ikenberg et al, 2020, Jesus et al, 2021, Lavine & Hardy, 2022, Saini et al, 2022, Wartelle et al, 2021, Wongtanasarasin et al, 2020 In order to analyze the impact of the pandemic on the work of the emergency services in Skopje, a…”

Section: Introductionmentioning

confidence: 99%

Effects of the Covid-19 Pandemic on the Visits Frequencies in Emergency Service Skopje

Stojanovska

Zdravkovska

Stojanovska

2022

IJMSR

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The pandemic caused by the COVID -19 virus has affected human health, consequently the health system and health services, both worldwide and in the Republic of North Macedonia. The idea for this research was therefore to examine the impact of the conditions imposed by the pandemic on the visits of the Emergency medical service in Skopje. For this purpose, the frequencies of visits with transport to hospital and just visits, as well as the frequencies of emergency calls and calls only for transport in the periods: before the pandemic (March 2019-February 2020) and during the pandemic (March 2020 to February 2021) were analyzed. The overall number of visits was further analyzed by categories: age and gender. In the period from March 2019 to March 2021, a total of 49,930 visits were performed, of which 24,115 were performed during the pandemic and 25,815 before. In the same period, a total of 13,835 emergency calls were answered, of which 6,434 were during the pandemic and 7,401 before; a total of 9780 calls for transport of patients were carried out, during the pandemic 5602 and 4178 before the pandemic. The analysis showed that the number of transports was increased and the number of emergency calls decreased during the pandemic compared to the pre-pandemic period, while the number of visits during and before the pandemic did not differ significantly. Concerning age and gender, the analysis showed that the number of visits to children, men aged 20 to 40 and women over 60 years was significantly reduced compared to pre-pandemic visits, while there was no difference in other age groups. The contributions of visits related to certain diagnostic and a particular age group are discussed in this paper. We found that the pandemic has not influenced the pace of work, apart from the conditions, only the association between the kind of calls and the diagnoses for which the visits were made has practically changed. During the pandemic, most visits for males and females over 40 were related to COVID diagnosis, while for children, men and women under 40, accidents were the most common cause.

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Impact of lockdown on medical emergency visits during the COVID-19 pandemic in India

Cited by 8 publications

References 5 publications

Prognostic significance of poison-related factors and consumption patterns in acute aluminum phosphide poisoning

Prognostic significance of poison-related factors and consumption patterns in acute aluminum phosphide poisoning

Changing spectrum of acute poisoning in North India

Effects of the Covid-19 Pandemic on the Visits Frequencies in Emergency Service Skopje

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