Indian Journal of Emergency Medicine

Context: Disturbances in mineral metabolism are commonly seen in patients with chronic renal failure. But there are very few studies on their prevalence in Indian dialysis population. Aim: To know the prevalence of secondary hyperparathyroidism in patients with stage 5 chronic kidney disease on maintenance hemodialysis. Settings and Design: Hospital based cross sectional study. Methods and Material: This study was done on 85 patients undergoing maintenance hemodialysis for > six months. and data was collected between January 2018 and December 2018, for a period of one year.Patients were examined for clinical features of secondary hyperparathyroidism and serum calcium, phosphorus, alkaline phosphatase, 25 hydroxy vitamin D and intact parathyroid hormone levels were measured. Statistical analysis used: The data was analysed with SPSS using Descriptive statistics, Chi-square testand significance by p value. Results : Various mineral, bone abnormalities in our study population were as follows- hypercalcemia (5.88%), hypocalcemia (36.47%), hyperphosphatemia (30.59%), hypophosphatemia (28.24%), hyperparathyroidism (36.48%), hypoparathyroidism (10.59%), deficiency of vitamin D(52.94%) and insufficiency of vitamin D (20%). Conclusions: Prevalence rate of secondary hyperparathyroidism was 36% in our study and 40% had over suppresion of iPTH levels. One third of our patients had a risk of adynamic bone disease.

Keywords: Chronic kidney disease; Secondary hyperparathyroidism; hemodialysis.

Superior mesenteric artery thrombosis (SMA) is a rare but potentially fatal disease. With the rapid increase in imaging modalities for patients with abdominal pain like biphasic CT scan1 and multidetector biphasic CT angiography2. There are two main intervention strategies for treatment of acute superior mesenteric artery occlusion namely endovascular revascularization of superior mesenteric artery and open surgery where the favourable outcome was more with endovascular revascularization therapy when compared to open surgery.3

Keywords: Superior Mesenteric Artery; Occlusion; Pain abdomen.

Context: Disturbances in mineral metabolism are commonly seen in patients with chronic renal failure. But there are very few studies on their prevalence in Indian dialysis population. Aim: To know the prevalence of secondary hyperparathyroidism in patients with stage 5 chronic kidney disease on maintenance hemodialysis. Settings and Design: Hospital based cross sectional study. Methods and Material: This study was done on 85 patients undergoing maintenance hemodialysis for > six months. and data was collected between January 2018 and December 2018, for a period of one year.Patients were examined for clinical features of secondary hyperparathyroidism and serum calcium, phosphorus, alkaline phosphatase, 25 hydroxy vitamin D and intact parathyroid hormone levels were measured. Statistical analysis used: The data was analysed with SPSS using Descriptive statistics, Chi-square testand significance by p value. Results : Various mineral, bone abnormalities in our study population were as follows- hypercalcemia (5.88%), hypocalcemia (36.47%), hyperphosphatemia (30.59%), hypophosphatemia (28.24%), hyperparathyroidism (36.48%), hypoparathyroidism (10.59%), deficiency of vitamin D(52.94%) and insufficiency of vitamin D (20%). Conclusions: Prevalence rate of secondary hyperparathyroidism was 36% in our study and 40% had over suppresion of iPTH levels. One third of our patients had a risk of adynamic bone disease.

Keywords: Chronic kidney disease; Secondary hyperparathyroidism; hemodialysis.

Atropine is the most commonlyused drug for the treatment of organophosphorus poisoning which may occasionally lead to central nervous system side effects like psychosis and delirium. Discontinuation of atropine, modification of the dosage or replacement with other medications may be required alongwith antipsychotics and sedatives in such cases. We report herein a case of suicidal ingestion of organophosphorus insecticide (ANACONDA) who received atropine infusion for the management of muscarinic symptomsbut developed psychotic features during treatment. Atropine was discontinued and replacement done with glycopyrrolate infusionwhich could successfully counteract the muscarinic features. The use of glycopyrrolate as replacement in atropine psychosis and the recommended dosage regimen has been sparsely described in literature.

Keywords: Organophosphorus poisoning; Atropine psychosis; Glycopyrrolate; Bronchorrhoea.

Acute onset quadriplegia is a potentially treatable neurological emergency. Common etiologies include radiculoneuropathies, compressive and non-compressive myelopathies. Spontaneous non traumatic spinal epidural hematoma is a relatively uncommon phenomenon. Here we report an interesting patient who developed coagulopathy related spinal epidural hematoma resulting in acute painful quadriplegia as a complication of hepatitis A infection.

Keywords: Coagulopathy; Spontaneous spinal epidural hematoma; Hepatitis A; Quadriplegia.

Context: Severe acute respiratory distress corona virus 2 (SARS COV 2) unleashed an unprecedented medical emergency and led to exemplary global containment response to limit the Corona Virus disease (COVID-19). These responses began in the initial phase of the pandemic itself and came at the cost of non-COVID hospital services. Aims: The aim of this study was to highlight the profile of patients, their outcomes and predictors of mortality in non-traumatic emergencies presenting to the non-Covid section of a north Indian tertiary care center during the early phase of COVID outbreak. Settings and Design: Single center observational study. Methods: After obtaining Institute ethics committee approval, data of patients presenting in emergency from February 1, 2020 to April 30, 2020 were obtained retrospectively. Patients coming with trauma related emergencies were excluded. Statistical analysis used: The data was categorized as survivors and non-survivors. Student t test/Mann Whitney test was used to compare continuous variables and Chi square test was used to compare categorical data. Univariate and multivariate binary logistic regression analysis were used to identify the predictors of non-survival. Results: Out of 800 patients admitted in emergency, 2 were found to be SARS COV2 positive. Of the remaining 798 patients, 27 (3.4%) patients expired. On multivariate analysis, greater age, hemoptysis, oxygen or ventilatory requirement and need of vasopressors at admission were predictors of non-survival. Conclusions: Greater age, need for oxygen, ventilator and vasopressors at time of admission are harbingers of mortality among non-Covid patients presenting in emergency.

Keywords: Non-Covid; Emergency; Predictors; Mortality.