RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,

BANGALORE, KARNATAKA.

PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION

1. / Name of the candidate and Address (in block letters) / DR. VANISHREE
POSTGRADUATE IN PHARMACOLOGY
DEPT OF PHARMACOLOGY
RAICHUR INSTITUTE OF MEDICAL SCIENCES,
RAICHUR. 584102.
2. / Name of the Institution / RAICHUR INSTITUTE OF MEDICAL
SCIENCES, RAICHUR
3. / Course of study and subject / M.D PHARMACOLOGY
4. / Date of admission to the course / 19 AUGUST 2013
5. / Title of the topic:
“ A PROSPECTIVE STUDY OF VARIOUS POISONING, PHARMACOLOGICAL MANAGEMENT AND THEIR OUTCOME IN A TERTIARY CARE HOSPITAL, RIMS RAICHUR”.
6. / BRIEF RESUME OF INTENDED WORK.
6.1 / Introduction and need for the study
Poisonings constitute a major cause of hospitalization and mortality in
developed as well as developing nations. The severity and outcome in such cases are determined by a number of factors such as chemical and physical properties of the poison amount consumed, mode of poisoning and individual characteristics like the functional reserve of the individual or target organ, which is further influenced by age and pre-existing disease. Among the various causes of poisonings, pesticides are the most common cause of self poisoning worldwide.1-3
Each year, 500,000 deaths occur in rural Asia due to suicide, and 200,000 of these deaths are due to self-organophosphates (OP) poisoning. The medical management of poisoning emergencies is difficult and, till date, there are no clear-cut evidence-based guidelines for the best management of OP poisoning.4
With the progress in the industrial and agricultural field and advances in medical sciences a vast number of insecticides have become available, which on exposure may produce severe toxicity. Information available in our country is limited, with regard to acute poisoning in adults, including hospitalized patients.5-9. In general, accidental poisoning is more common in children, whereas suicidal poisoning is more common in young adults.5 A study from Vellore has shown an increasing trend of self-poisoning, especially among young adults.9
It is important to know the nature and severity of poisoning in order to take appropriate preventive measures. Studies of this nature will be a useful tool in planning and management of acute poisoning cases.
Hence, this prospective study of various poisoning will be conducted with an aim to assess the pattern, severity, management and factors determining the outcome of critically ill acute poisoning cases in a tertiary care hospital.
6.2 / Review of Literature:
§  A study conducted by Bhoopendra Singh, Unnikrishnan B at mangalore. The aim of the study was evaluating the sociodemographic characteristics, and agent’s used for the acute poisoning. The study design method was retrospective and duration of 28 months. A total of 33,207 patients were taken for the studies among this 325 patient were found with acute poisoning. The incidence of poisoning were more common in male (70%) than female (30%). Intentional poisoning was 72% and unintentional 27%. More agents used for acute poisoning were agrochemical pesticides (49%), drugs (17%) and alcohol (13%). The mortality rate was more with organophosphate (65%) than aluminium phosphide (15%). This study concluded that prevention and treatment of poisoning due to organophosphate and aluminium phosphide should have high priority in the health care of indigenous population of south India.10
§  Michale Eddleston et al. conducted a study on “Early management after self –poisoning with an organophosphorus or carbamate pesticide. A protocol was developed to guide for junior doctors with in the rural area for early management of severely ill, unconscious organophosphorus /carbamate poisoning cases. This study concluded that careful resuscitation with appropriate use of antidotes, followed by good supportive care and observation should minimize the number of death in the period after admission to hospital.11
§  One more study was conducted on pattern and outcomes of acute poisoning cases in a tertiary care hospital. The objective of this study was assessing the pattern and outcomes of acute poisoning in a hospital. This is a retrospective study included 136 cases, the poisoning incidence was more common among males (75.4%) compare to female (24.3%) with a ratio of 3:1. The poisoning cases were found between the age group of 20 to 29 year (31.2%) and 12 to 19 age group (30.2%). The commonly used agent for poisoning was organophosphorus (36%), total mortality was found to be 15.4%. This study concluded that poisoning is more common in young males. The overall mortality was very high. Early care in a tertiary care hospital may help to reduce mortality in India.12
§  Samuel J et al conducted a randomized controlled trial in 72 patients between Aug 1991 and Dec 1992 at Christian medical college in Vellore, India. A 1gm bolus of pralidoxime was compared with 12gm given as a reducing infusion over 4 days without a loading dose. This RCT reported an increased mortality rate(22% vs 14%) and increased requirement for ventilation(67% vs 47%) among patients who received the infusion compared with those who received the bolus dose. The authors concluded that high dose high dose pralidoxime was therefore associated with a worse outcome and should have no role in the routine management of patients with OP poisoning.13
§  Shaikh JM conducted a study on “Management of acute organophosphorus poisoning at a University hospital”. The objective of the study was documentation of the management, complication and subsequent outcome of acute organophosphorus poisoning patient in the ICU (Intensive Care Unit). The study was conducted in 111 patients among this 60.4% of patients were males, 89.2% of cases were with suicidal attempt. The ICU stay mean was 2.3 ± 3.2 days. Twenty patients (18%) needed mechanical ventilator support. The overall mortality rate was 9%, the mortality rate for the patient who required mechanical ventilation was 40%, but the rate was 2.2% for the patients who were not mechanically ventilated. This concluded that it is very difficult to reduce mortality by primary prevention. Immediate shifting of the victim to a well equipped and well staffed ICU, careful resuscitation with appropriate use of antidotes and good supportive care can reduce the number of deaths after admission to the hospital.14
6.3 / Objective of the Study
1.  To know socio-demographic related characteristics in poisoning cases.
2.  To study the pattern, severity and organ involvement of different poisoning.
3.  To study the pharmacological management of poisoning cases.
4.  To determine the factors associated with outcome of poisoning.
5.  To determine the final outcome of poisoning.
7. / MATERIALS AND METHODS
7.1 / Study design:
A prospective, observational study by procuring documented data will be done in poisoning cases attending at Raichur Institute of Medical Sciences, Raichur.
7.2 / Study period:
January 2014 to December 2014.
7.3 / Source of data:
Poisoning cases attending at Raichur Institute of Medical Sciences, Raichur.
7.4 / Method of collection of data:
During the study period patients satisfying the inclusion criteria will be individually recognized and following information will be collected using semi structured questionnaire, interviewing the patient or his/her relative which is pre structured and pre tested.
Data will also be collected from patient’s case sheet.
1.  Sociodemographic details
2.  Mode and type of poisoning
3.  Lag time in treatment
4.  First aid
5.  Treatment given to prior admission
6.  Treatment given after admission
7.  Organ involved
8.  Duration of hospitalization
9.  Complications
10. Final outcome of poisoning
7.5 / Inclusion criteria:
1.  Suspected case of poisoning aged 12years or above of either sex.
2.  Patients who are hospitalized for more than 24hours.
7.6 / Exclusion criteria:
1.  Patients of paediatric age group.
2.  Patients having co-morbid conditions.
3.  Patients died before clinical evaluation.
4.  Patients who get discharge against medical advice.
7.7 / Sample size:
All the cases of poisoning who are admitted to Raichur institute of medical sciences, hospital which fulfills the inclusion criteria from January 2014 to December 2014 will be taken for study.
7.8 / Statistical analysis:
Descriptive statistics comprising mean, standard deviation, proportion and percentage shall be used to describe the data. Chi-square of proportion shall be used to compare the statistical significance of difference between the various proportions in the study.
7.9 / Does the study require any investigation or interventions to be conducted on patients? Or other humans or animals?
No. ( Baseline and recent investigations done will be collected from patient treatment record )
7.10 / Has ethical clearance been obtained from your institution?
Yes, Ethical clearance has been obtained from Institutional Ethics Committee. Raichur Institute of Medical Sciences, Raichur.
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14 / LIST OF REFERENCES
Bertolote JM, Fleischmann A, Butchart A, et al. Suicide, suicide attempts and pesticides: a major hidden public health problem. Bull World Health Organ 2006; 84: 260.
Khan NA, Rahman A, Sumon SM, et al. Pattern of poisoning in a tertiary level hospital. Mymensingh Med J 2013; 22: 241–247.
Mandour RA. Environmental risks of insecticides cholinesterase inhibitors. Toxicol Int 2013; 20: 30–34.Eddleston M, Gunnell D, Karunaratne A, de Silva D, Sheriff MH, Buckley NA. Epidemiology of intentional self poisoning in rural Sri Lanka.Br J Psychiatry.2005; 187:583–4.
Eddleston M, Gunnell D, Karunaratne A, de Silva D, Sheriff MH, Buckley NA. Epidemiology of intentional self poisoning in rural Sri Lanka.Br J Psychiatry.2005;187:583–4
Das RK. Epidemiology of Insecticide poisoning at A.I.I.M.S Emergency Services and role of its detection by gas liquid chromatography in diagnosis. Medico update.2007;7:49–60. Unnikrishnan B, Singh B, Rajeev A. Trends of acute poisoning in South Karnataka.Kathmandu Univ Med J (KUMJ)2005; 3:149–54.
Unnikrishnan B, Singh B, Rajeev A. Trends of acute poisoning in South Karnataka.Kathmandu Univ Med J (KUMJ)2005; 3:149–54.
Dash SK, Aluri SR, Mohanty MK, Patnaik KK, Mohanty S. Sociodemographic profile of poisoning cases.JIAFM.2005; 27:133–8.
Srivastava A, Peshin SS, Kaleekal T, Gupta SK. An epidemiological study of poisoning cases reported to the National Poisons Information Centre, All India Institute of Medical Sciences, New Delhi.Hum Exp Toxicol.2005; 24:279–85.
Thomas M, Anandan S, Kuruvilla PJ, Singh PR, David S. Profile of hospital admissions following acute poisoning-experiences from a major teaching hospital in south india.Adverse Drug React Toxicol Rev.2000; 19:313–17.
Singh B, Unnikrishnan B. A profile of acute poisoning at Mangalore. Journal of Clinical Forensic Medicine 2006; 112-6.
Eddleston M, Dwason AH, Karalliedde L, Dissanayake W, Hittarage A, Azher S, et al. Early management after self – poisoning with an organophosphorus or carbamate pesticide – a treatment protocol for junior doctors. Critical Care 2004; 8:R391-7.
Ramesha KN, Krishnamurthy Rao BH, Ganesh SK. Pattern and outcome of acute poisoning cases in a tertiary care hospital in Karnataka, India. Indian Journal of Critical Care Medicine 2009; 13(3):152-5.
Samuel J, Peter JV, Thomas K, Jeyaseelan L, Cherian AM. Evaluation of two treatment regimens of pralidoxime (1gm single bolus dose vs 12gm infusion) in the management of OP poisoning. J Assoc Physic India 1996; 44:529-31.
Shaikh JM. Management of acute organophosphorus poisoning at a university hospital. Critical Care 2008; 12(2):357-8.
9. /

Signature of candidate

10. / Remarks of the Guide / Poisoning cases are more common in this area, hence study is recommended for evaluation of therapeutic management of poisoning.
11.
/ Name and designation of
(in block letters)
11.1 Guide
11.2 Signature
11.3 Co-guide
11.4 Signature / DR. VASANT .R.CHAVAN MD
PROFESSOR & H.O.D.
DEPT. OF PHARMACOLOGY
RIMS, RAICHUR.
DR. BASAVARAJ.M.PATIL MD
ASSOCIATE PROFESSOR & H.O.D
DEPT. OF GENERAL MEDICINE,
RIMS, RAICHUR
11.5 Head of the Department
11.6 Signature / DR. VASANT.R.CHAVAN MD
PROFESSOR & H.O.D.
DEPT. OF PHARMACOLOGY,
RIMS, RAICHUR.
12 / 12.1 Remarks of the Dean/Director

12.2 Dean cum Director
12.3 Signature / DR. BASAVARAJ .V.PEERAPUR M.D
I/C DEAN/DIRECTOR
RAICHUR INSTITUTE OF MEDICAL SCIENCES, RAICHUR