Epidemio-toxicological profile of fatal poisoning cases autopsied at a tertiary care centre of North India

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 1^st January 1998 to 31^st 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 3^rd 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 2^nd to 4^th 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.

Diabetic Foot Care Knowledge and Practices in Rural North India: Insights for Preventive Podiatry

BACKGROUND

Diabetic foot ulcer (DFU) is one of the most dreaded complications of Type 2 Diabetes Mellitus (T2DM). Preventive podiatry is most efficient way of minimising DFU. The main aim of the study was to assess the knowledge and foot care practices among patients living with T2DM concerning the DFU.

MATERIALS AND METHODS

We conducted a cross-sectional study in a rural-area of Haryana, India between January to March 2019 amongst 416 people living with T2DM after using multistage random sampling. A pre-tested, structured survey instrument prepared from the recommendation of the American College of Foot and Ankle Surgeons and the Diabetes UK was used after Hindi translation as per standard protocol. The knowledge and practices were classified as good, satisfactory and poor if the total score was between 8-11, 6-7 and <6.

RESULTS

14.2% had a previous history of DFU. The prevalence of good, satisfactory and poor knowledge was 63.5%, 12.5% and 24.0%. Further, 46.7%, 32.7% and 20.6% respondents depicted good, satisfactory and poor practices regarding foot care. On multivariate binary logistic regression analysis, younger age group, higher education, Per capita family income in INR, Blood glucose levels, HbA1c Levels, physical activity and previous history of DFU emerged as significant predictors of good foot-care knowledge and practices.

CONCLUSION

There is an evident gap between foot-care knowledge and practices that should be addressed through comprehensive behaviour change strategies. Comprehensive risk-assessments for diabetes associated complications needs to be piloted at community level to assess the feasibility.

Childhood Adversities as Risk Factors and Persistence of Suicidal Behavior: A Descriptive Cross-Sectional Study

Suicide is one of the important cause of death worldwide. The precise effect of childhood adversities as risk factors for the onset and persistence of suicidal behaviour are not well understood. A descriptive cross sectional study was carried out in the department of Psychiatry, Cumilla Medical College, Cumilla, Bangladesh. All cases were selected from patients attending at Cumilla Medical College hospital and Private Hospitals in Cumilla City from April 2017 to September 2018. We found out the association between childhood adversities and suicidal behaviour over the life course and delineated the types of suicidal behavior. Total 120 cases were included in the study. Respondents provided socio-demographic and diagnostic information, childhood adversities as well as an account of suicide-related thoughts and behaviours. A participation rate was 77.5% female. Of 120 suicidal behavior participants physical abuse was 2.5%, sexual abuse was 16.67%, parental death was 5%, parental divorce was 2.5%, other parental loss was 4.17%, family violence was 5%, physical illness was 1.67%, financial adversity was 3.33% and composite adversity was 59.16%. Among childhood adversities participants suicidal ideation was 70%, suicidal plans was 15.83%, suicidal attempts was 45%, ideators only proceeded to plans was 22.5%, ideation to attempt was 63.33%, planned attempts was 10.83% and impulsive attempts was 52.5%. Among suicidal behavior participant's psychiatric disorders were 65%. Where neurotic disorders were 17%, psychotic disorders were 13%, personality disorders were 44% and others disorder was 26%. Most of the suicidal behavior patients were female 77.5% and age group of 18-24 years. Childhood sexual abuse emerged as a particularly robust risk factor for suicide attempts in younger participants. Childhood physical and sexual abuse emerged as risk factors for the emergence and persistence of suicidal behaviour, especially in adolescence. Two or more childhood adversities were associated with a three fold higher risk of lifetime suicide attempts. Childhood adversities are main risk factors for the onset and persistence of suicidal behaviour. The risks being are the greatest in childhood, adolescence and early adult. A longitudinal follow-up study is required to give a more reliable in Bangladesh.

Overcoming the health system barriers to early diagnosis and management of multidrug-resistant tuberculosis in a rural setting in North India

India contributes a quarter of the global burden of multidrug-resistant tuberculosis (MDR-TB) and has inadequate diagnostic infrastructure and institutional capacities for drug susceptibility testing. Subsequently, this leads to a large number of undetected and untreated cases of MDR-TB. In this report, we describe a case of a 55-year-old man from rural North India presenting with complaints of continued symptoms of chronic cough, fever and dyspnoea despite being recently diagnosed with recurrent tuberculosis and receiving treatment from the local community health centre. MDR-TB was suspected, but confirmatory diagnostic capabilities were not available in the local setting. The patient was finally diagnosed with MDR-TB. Treatment was coordinated by the district tuberculosis programme officer. Through this case, we describe the various barriers to detecting MDR-TB in the rural regions of India. Prompt identification of patients with presumptive MDR-TB, diagnosis of the disease and initiation of treatment are crucial to preventing disease transmission and reducing morbidity and mortality.

Are our subcenters equipped enough to provide primary health care to the community: A study to explore the gaps in workforce and infrastructure in the subcenters from North India

Background

A Sub-Centre (SC) is most peripheral and first point of contact between the primary healthcare system and the community in the rural areas. The success of any nationwide program largely depends on well-functioning SCs providing services of acceptable standards to people. Indian Public Health Standards (IPHS) for SCs was prepared keeping in view the minimum standards required to provide quality and need sensitive health care to the community.

Materials and Methods

A cross-sectional study was conducted in Ambala District of Haryana to assess the availability of physical infrastructure, manpower, drugs and equipment in the SCs. A total of 30 SCs from a rural block was selected. The data was statistically analyzed using Microsoft Excel. The deficiencies in the availability of health workers male and female were found to be 66.6% and 50%, respectively. The residential facility for health workers was available only in 33.3% SCs but none being utilized. Although labour room with labour table was present in half of the Sub Centers, the deliveries were found to be conducted in none of those. Only 40% and 26.6% of SCs had stethoscope and functional B.P apparatus. The availability of essential drugs and equipment was also poor.

Conclusion

The physical infrastructure and manpower availability at the SCs needs considerable improvement as per the Indian Public Health Standard (IPHS). Poor availability of essential drugs and equipment needs to be addressed at the earliest.

So near, yet so far: access to safe abortion services remains elusive for poor women in India

In this case study, we describe our experiences with a woman employed as a housemaid who sought unsafe abortion services from a private doctor. This was her sixth pregnancy, after previously giving birth to one son and two daughters and undergoing two induced abortions. Her husband remained opposed to the use of contraception. Initially, she had sought medical termination of pregnancy through a government hospital but was denied because of procedural delays, specifically the non-availability of an ultrasonography report consequent to a lack of proof of identity (ie, the AADHAAR card, a unique identification card for recording biometric and demographic data in India). She finally sought the services of an unqualified private physician and received oral abortifacient agents. Consequently, she was required to seek treatment for bleeding per vaginum from the dispensary staff at a government hospital. We note that many such incidents occur in our daily practice but remain unnoticed and undocumented. Although this patient was eligible for sterilisation (ie, tubectomy), her husband was uncooperative. This case illustrates the lack of decision-making power experienced by Indian women who have a low societal status.

Evaluation of fungicides on fungi associated with fruit rots and leaf spots of brinjal

DOI: http://dx.doi.org/10.3329/dujbs.v23i1.19833 Dhaka Univ. J. Biol. Sci. 23(1): 97-99, 2014

Comparison of coronary CT angiography with conventional coronary angiography in the diagnosis of coronary artery disease

Noninvasive CT coronary angiography is a promising coronary imaging technique. In spite of the unprecedented temporal and spatial resolution and the inability to perform therapeutic interventions in the same session multi-detector computed tomography (MDCT) has been considering a promising alternative, non invasive tool for coronary artery imaging due to its high sensitivity and specificity for the detection of significant coronary artery stenosis. To evaluate the diagnostic accuracy of 64-slice MDCT for assessing haemodynamically significant stenoses of the coronary arteries in comparison with the conventional standard cardiac angiography. Fifty patients scheduled for conventional coronary angiography at the department of Radiology and Imaging, United Hospital, Dhaka were enrolled between July 2007 and June 2008. All patients underwent both conventional and MDCT angiography within mean 10.70 days. Overall sensitivity of 64-slice MDCT for the detection of stenosis ≤ 50%, stenosis > 50%, and stenosis > 75% was 90.0%, 83.8%, and 80.7%, respectively, and specificity was 96.5%, 98.4%, and 98.3% respectively and accuracy was 96.0 %, 96.5%, and 96.6% respectively. Contrast-enhanced 64-slice MDCT allows the identification of coronary stenosis with excellent accuracy. Measurements of stenosis derived by MDCT correlated well with conventional angiogram. A major limitation is the insufficient ability of CT to exactly quantify the degree of stenosis.

Melanotic neuroectodermal tumour of infancy

Melanotic neuroectodermal tumour in infancy is rare, mainly benign with little tendency to recur after excision or effective curettage. This pigmented neoplasm of neural crest origin occurring in infants before 1 year of age. The most common site of occurrence is the anterior maxillary alveolar ridge (70%), following by the skull, brain and mandible. The genital organ is the most frequent extra cranial site. We report a 6 months old male baby with a similar tumour arising from right half of cheek involving the maxilla. We diagnosed the case after histological report. We remove the tumour through a sub-labial incision. The mass was blackish in colour, and was mobilized from all side including from the maxillary sinuses. The author thought that this should be reported for improving the clinical awareness and treatment of pigmented soft tissue mass in children. Almost one year follow up of the patients showed no recurrence.

Mucoepidermoid carcinoma of the lung--a case report

Mucoepidermoid carcinoma is an uncommon primary lung tumor. Mucoepidermoid carcinomas have been reported in all age group and equally in both sexes. A case of mucoepidermoid carcinoma histologically confirmed by biopsy is reported here. The patient is a 15 years old male presented with cough and dyspnoea for 5 days. Chest roentgenography showed segmental consolidation of right lower lobe. Chest computed tomography revealed a soft tissue mass with calcification within the lumen of lower trachea in precarinal location. The patient underwent thoracotomy for endotracheal mass and resection was done. Following operation, the patient is symptom free and follow-up CT scan shows normal tracheal outline.

Ruptured aneurysm of the sinus of Valsalva

The objective of the present study was to assess the value of imaging techniques in the diagnosis of ruptured aneurysm of sinus of Valsalva (RASV). 38 patients were included in the study. 30 were male and 8 female. Their age ranged from 7 to 55 years (mean 25.8 years). Echocardiographic and doppler studies were done in all cases and 20 patients underwent catheterization and angiography. Two patients were asymptomatic, 20 (53%) had acute onset of symptoms and in the remaining 16 (42%) patients symptoms developed gradually. Twenty two (58%) patients were in NYHA functional class III or IV when first seen. Predominant symptoms were dyspnea (79%), palpitation (55%) and chest pain (52%). A continuous machinery murmur was detected in all the patients with associated thrill in 34 patients. Right coronary sinus (RCS) was the most common sinus involved (89%) followed by the noncoronary sinus (NCS) which was involved in 11% of patients. None of the patients in our series had aneurysm of the left coronary sinus. Twenty eight of the 34 RCS aneurysms ruptured into the right ventricular outflow tract (RVOT), 4 into right ventricular cavity (RVC), one into right atrium (RA) and one dissected into the ventricular septum and subsequently ruptured into the left ventricle. Of the 4 NCS aneurysms, 2 ruptured into RVC, one into RA and one into both the RA and RVC. Associated ventricular septal defect (VSD) was found in 10 (26%) patients and all of these patients had RCS aneurysm that ruptured into the RVOT. Aortic regurgitation (AR) was detected in 16 (42%) cases. Discrete subaortic stenosis was detected in one patient who also had associated VSD and AR. Vegetation of the aortic valve was detected in one patient who had RCS aneurysm. Twelve patients (11 male and one female) underwent surgical correction, 10 with and 2 without prior catheterization. Localization of the involved sinus, site of rupture and associated cardiac lesions by echocardiography and doppler study were found accurate at surgery and/or angiography in 22 cases of our series. Imaging techniques, thus appeared to be reliable tools for the diagnosis of RASV.

Clinical and angiographic profile of Takayasu's arteritis in Bangladesh

Nineteen patients (11 female and 8 male) with a mean age of 22.7 years (range 10 to 35 yrs) with Takayasu's arteritis were studied between July 1985 to June 1993. These patients had both non vascular symptoms (myalgia/arthralgia in 47% and weight loss in 31%) and symptoms of vascular insufficiency such as arm claudication or numbness (37%) and hypertension due to renal artery involvement (73%). Vascular bruits were found in 73% and diminished or absent pulses was detected in 52% of patients. All patients had arterial involvement at multiple sites documented by aortography with various combinations of stenosis, irregularity of arterial lumen and aneurysm formation. Angiographic type II was most frequent (47%) form found in our series. Five patients (26%) had pulmonary artery involvement. We conclude that hypertension is one of the most common manifestation of Takayasu's arteritis in these patients and renal artery stenosis is the most common cause of hypertension.

Primary pulmonary hypertension: clinical, echocardiographic and haemodynamic features in 14 patients

Clinical, echocardiographic and haemodynamic features in 14 patients (8 male and 6 females) with primary pulmonary hypertension, diagnosed by strict clinical and haemodynamic criteria are described. Age of the patients at diagnosis ranged from 11 years to 40 years with a mean of 23 years. The mean interval from onset of symptoms to diagnosis was 2.6 years. Common symptoms included dyspnoea on exertion (86%), fatigue (78%) and palpitation (78%). Raynaud's phenomenon was not encountered but one patient had signs and symptoms of left recurrent laryngeal nerve palsy. Pulmonary function studies showed mild restrictive ventilatory impairment (mean forced vital capacity 80% of predicted) with hypoxaemia and hypocapnea. The M-mode tracing of the pulmonary valve showed flat or negative E-F slope, a small or absent 'a' wave, and midsystolic notching in all the patients. Two-dimensional echocardiographic images showed a thickened right ventricular wall in 12(86%) patients; a normal to small left ventricular end-diastolic internal dimension in all the patients and right ventricular and right atrial enlargement in 78% of patients. Significant tricuspid regurgitation and pulmonary regurgitation was documented by Doppler interogation in 87% and 62% of patients examined respectively. Haemodynamic findings consisted of a marked rise of pulmonary artery pressure and pulmonary vascular resistance, low cardiac index and normal pulmonary artery wedge pressure. At cardiac catheterisation the mean right atrial pressure (mean +/- SD) was 9.8 +/- 4.8 mmHg; mean pulmonary artery pressure, 63.2 +/- 14.3 mmHg; cardiac index, 2.2 +/- 0.9 L/min. m2; and pulmonary vascular resistance index, 22.3 +/- 10.6 mmHg/L/min. m2; in these patients. No, death nor any sustained morbid events occurred during the diagnostic evaluation of the patients.