Burden of poisoning on a critical care unit in southern India.

Background: Poisoning inflicts a considerable economic cost on the health sector. Few cases of poisoning may require intensive management in a critical care unit and thus add to the financial burden. In this study, our primary objective was to analyse the financial burden of poisoning on critical care facilities and the secondary objective was to analyse the critical care needs and treatment outcomes of patients with poisoning. Methods: We did this retrospective study of patients admitted with poisoning in the critical care unit of Government Medical College Hospital, Thiruvananthapuram, Kerala (12- bedded critical care unit of 2500-bedded medical college hospital) from January 2011 to December 2013. Patients <13 years of age were excluded. Cost was estimated using the hospital expenditure data. Results: A total of 118 patients, comprising 2.5% of the total critical care unit admissions, were included in the study. The average cost of providing critical care for cases of poisoning was ₹367 333 per annum. Organophosphorus poison was the most common agent (33.9%) with the highest cost per admission of approximately ₹1 8 500. The highest number of deaths was due to phosphide poisoning with a case fatality rate of 83%. Conclusions: Poisoning imposes a considerable burden on the limited critical care services. Organophosphorus was the most common substance consumed for poisoning and it led to the highest expenditure per admission.

Major outcomes of patients with tuberculous meningitis on directly observed thrice a week regime.

BACKGROUND: Revised National Tuberculosis Control Programme (RNTCP) of Government of India provides intermittent thrice-a-week directly observed treatment short course (RNTCP regimen). OBJECTIVE: Assessments of all-cause mortality and nine-month morbidity outcomes of patients with tuberculous meningitis (TBM) on RNTCP regimen. MATERIALS AND METHODS: We prospectively followed up patients registered with RNTCP center, with a diagnosis of TBM from January 1(st), 2010 to December 31(st), 2011. Morbidity was assessed using modified Rankin Scale (mRS). RESULTS: We had 43 patients with median duration for follow-up of 396 days and that of survivors of 425 days. Two patients defaulted. Fourteen patients (32.5%) had mRS score of 4 to 6 and 29 had mRS of 0 to 3 after 9-month treatment. Severe disability was not related to any factor on logistic regression. Severe disability was seen in one patient (6.66%) among the 15 patients with stage 1, nine (37.5%) out of 24 patients with stage 2 and three (75%) out of 4 patients with stage 3 disease. Eight patients died (18.6%) of whom 4 died during the intensive phase and 4 during the continuation phase of RNTCP regimen. Mortality was independently related to treatment failure with adjusted Hazard ratio of 8.29 (CI: 1.38-49.78) (P = 0.02). One patient (6.66%) died out of the 15 patients with stage 1 disease, 5 (20.8%) out of 24 patients with stage 2 disease and 2 (50%) out of the 4 with stage 3 disease. DISCUSSION AND CONCLUSION: RNTCP regimen was associated with good compliance, comparable mortality and morbidity.