Acute propafenone toxicity after two exposures at standard dosing.

A 72-year-old woman presented with a decreased level of consciousness and hypotension. The initial electrocardiogram demonstrated atrial fibrillation with a wide QRS complex. Her medical history revealed that she had just been started on propafenone. A diagnosis of propafenone toxicity was made and sodium bicarbonate was administered. A rare phenomenon in which toxicity occurred at therapeutic dosing is reported. Acute propafenone toxicity manifests in a wide range of organ systems; in particular, cardiovascular compromise in the form of hypotension, bradycardia and QRS widening can occur. Sodium bicarbonate therapy is advocated to directly counteract the toxic effects of propafenone. In the case described, this treatment resulted in rapid normalization of the QRS duration and stabilization of the hemodynamic profile.

Adverse reproductive and child health outcomes among people living near highly toxic waste water drains in Punjab, India.

BACKGROUND: Environmental influence plays a major role in determining health status of individuals. Punjab has been reported as having a high degree of water pollution due to heavy metals from untreated industrial effluent discharge and high pesticide consumption in agriculture. The present study ascertained the association of heavy metal and pesticide exposure on reproductive and child health outcomes in Punjab, India. METHODS: A cross-sectional community-based survey was conducted in which 1904 women in reproductive age group and 1762 children below 12 years of age from 35 villages in three districts of Punjab were interviewed on a semistructured schedule for systemic and general health morbidities. Medical doctors conducted a clinical examination and review of records where relevant. Out of 35 study villages, 25 served as target (exposed) and 10 as non-target (less exposed or reference). Effluent, ground and surface water, fodder, vegetables and milk (bovine and human) samples were tested for chemical composition, heavy metals and pesticides. RESULTS: Spontaneous abortion (20.6 per 1000 live births) and premature births (6.7 per 1000 live births) were significantly higher in area affected by heavy metal and pesticide pollution (p<0.05). Stillbirths were about five times higher as compared with a meta-analysis for South Asian countries. A larger proportion of children in target area were reported to have delayed milestones, language delay, blue line in the gums, mottling of teeth and gastrointestinal morbidities (p<0.05). Mercury was found in more than permissible limits (MPL) in 84.4% samples from the target area. Heptachlor, chlorpyriphos, beta-endosulfan, dimethoate and aldrin were found to be more than MPL in 23.9%, 21.7%, 19.6%, 6.5% and 6.5% ground water samples respectively. CONCLUSION: Although no direct association could be established in this study, heavy metal and pesticide exposure may be potential risk factors for adverse reproductive and child health outcomes.

Identifying missed opportunities to curtail antimicrobial therapy for presumed ventilator-associated pneumonia using the clinical pulmonary infection score.

BACKGROUND: Early discontinuation of antimicrobial therapy for ventilator-associated pneumonia can reduce the emergence of antimicrobial resistance, the occurrence of adverse drug events, and the cost of therapy. Evidence suggests that discontinuation of therapy by day 3 may be appropriate for patients with a clinical pulmonary infection score of 6 or less at baseline and on day 3. OBJECTIVES: To determine the proportion of patients eligible for antimicrobial discontinuation on day 3 and day 7 of therapy and to determine the proportion of eligible patients for whom antimicrobials were discontinued within these timeframes. METHODS: A 6-month observational study was conducted from October 3, 2005, to March 31, 2006, in a 27-bed medical-surgical tertiary care intensive care unit. Clinical pharmacists attended daily rounds and prospectively identified patients for inclusion in the study. A study pharmacist retrospectively calculated clinical pulmonary infection scores. Other data were obtained from the quality-improvement database and patient health records for the intensive care unit. RESULTS: Ninety-two patients were treated for ventilator-associated pneumonia during the study period, of whom 49 were included in the analysis. At day 3, 17 (35%) of the 49 patients were eligible for early discontinuation of antimicrobial therapy, but therapy was discontinued for only 2 (12%) of these 17 patients. At day 7, 10 (32%) of 31 patients were eligible for antimicrobial discontinuation, but therapy was discontinued for only 1 (10%) of these 10 patients. CONCLUSIONS: A significant opportunity exists at the authors' institution to develop and implement an antimicrobial discontinuation policy that uses the clinical pulmonary infection score to guide antimicrobial use for patients with ventilator-associated pneumonia.

Association of outdoor air pollution with chronic respiratory morbidity in an industrial town in northern India.

A cross-sectional study was performed in one industrial (study) and one non-industrial (reference) town in Punjab State, northern India. Ambient air quality samples were collected and analyzed each week for 2 yr. Subjects were 3,603 individuals >15 yr old who were interviewed and whose lung functions were measured spirometrically. Their biomarkers were categorized in terms of obstructive or restrictive defects. Levels of total suspended particulates, nitrogen oxides, sulfur oxides, carbon monoxide, and ozone were significantly higher in the study town than in the reference town. The prevalence of chronic respiratory symptoms (cough, phlegm, breathlessness, or wheezing) was 27.9 and 20.3% in the study and reference towns, respectively (p < 0.05). That of obstructive ventilatory defect was 24.9 and 11.8% (p < 0.05), respectively. Logistic regression analysis showed that residence in the study town was independently associated with chronic respiratory symptoms (odds ratio [OR] = 1.5; 95% confidence interval [CI] = 1.2, 1.8; p < 0.001) and spirometric ventilatory defect (OR = 2.4; 95% CI = 2.0, 2.9; p < 0.001) after controlling for other demographic effects.