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INTRODUCTION: Changing demographic patterns worldwide and improvement in healthcarehas contributed to increasing visits to the emergency department byelderly patients. Geriatric patients usually have multiple co-morbidities and declining physiological functional status. This complex interplay of various factors requires a specific and curated approach from the emergency physicians. Our aim was to study the pattern and prevalence of geriatric emergencies and the profile of infectious and non-infectious causes of fever in geriatric population in our tertiary care center. MATERIALS AND METHODS: This retrospective descriptive study was carried out at a tertiary care hospital of north India and included all patients aged more than 18 years who visited the emergency department over a period of six months (July 2018 to December 2018). Detailed data regarding demographic, clinical and diagnosis was obtained retrospectively from the hospital records system. The patients were divided into two groups, age less than 60 years and elderly patients more than 60 years of age for comparison. RESULTS: A total of 24768 patients above the age of 18 years visited the emergency department over a period of six months. Out of which 5399 (27.5%) patients belonged to the geriatric age group more than 60 years of age. 2474 (45.8%) geriatric age group patientswere triaged to critical areas level one and level two as compared to 4668 (24.1%) patients aged less than 60 years. Ninety (1.8%) geriatric patients succumbed to death as compared to 77 (0.4%) patients aged less than 60 years. 651 (21.9%) geriatric patients were shifted to intensive care unit as opposed to 1038 (14.8%) patients of the younger age group.226 (4.2%) geriatric patients presented with fever in the emergency department.116 (73.4%) patients having underlying co-morbidities , had fever due to infectious causes whereas 42 ( 26.5%) patients had fever due to non-infectious causes. CONCLUSION: The clinical presentation mortality and morbidity pattern of geriatric patients differs significantly from that of younger population and requires a customized approach and dedicated emergency setups.
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INTRODUCTION: Lead (Pb) is one of the major occupational pollutants present in the developed and developing countries including India. In humans, Pb can cause a wide range of biological effects depending upon the level and duration of exposure. The goal of this study was to evaluate the blood lead levels (BLLs) and its associated effects on vitamin D and calcium metabolism, among the workers occupationally exposed to Pb. MATERIALS AND METHODS: This cross-sectional, case-control study was conducted for a period of 18 months (January 2017 to July 2018). A total of 160 subjects were included in the study (80 in each, Pb-exposed group and control group). The blood Pb levels were quantified by using an inductively coupled plasma mass spectrometry with triple quadrupole technology (iCAP™ TQ ICP-MS). Other biochemical parameters were estimated using fully automatic analyzer by RANDOX, RX-imola, Crumlin, UK and Johnson and Johnson, VITROS® ECiQ, Immunodiagnostic system, Ortho Clinical Diagnostics, New Jersey, USA. RESULTS: Upon analysis it was observed that serum calcium, phosphorous, and vitamin D levels were significantly decreased (8.35 ± 0.42 mg/dl, 3.07 ± 0.34 mg/dl, and 28.82 ± 10.81 ng/ml respectively; P < 0.001), whereas the BLL and serum iPTH levels were significantly increased (38.02 ± 19.92 µg/dl and 116.78 ± 19.93 pg/ml respectively; P < 0.001) in Pb exposed subjects as compared to control subjects. CONCLUSION: Our study results demonstrated that high BLL significantly alter vitamin D and calcium metabolism. The data extrapolated from our study emphasizes the necessity of surveillance in exposed workers. As the associated deleterious effects of Pb-exposure can be serious, we propose that a routine-periodical screening of the workers exposed to lead should be conducted.
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BACKGROUND & OBJECTIVES: Phlebotomus argentipes (Diptera: Psychodidae), the established vector for kala-azar is presently being controlled by indoor residual spray of DDT in kala-azar endemic areas in India. Search for non-hazardous and non-toxic biodegradable active molecules from botanicals may provide cost-effective and eco-friendly alternatives to synthetic insecticides. The present study was aimed at evaluating various plant extracts from endemic and non-endemic areas of Bihar for their insecticidal activity against sandfly to identify the most effective plant extract. METHODS: Bio-assay test was conducted with larvae and adult of P. argentipes with different plant extracts collected in distilled water, hexane, ethyl acetate, acetone and methanol. Thin layer chromatography (TLC), column chromatography and high performance liquid chromatography (HPLC) were conducted for detection of active molecules. RESULTS: Adults and larvae of sandflies exposed to the aqueous extract of Nicotiana tabacum resulted in 100 per cent mortality. The hexane extract of Clerodendrum infortunatum was found to kill 77 per cent adults but was ineffective against larvae. Bio-assay test of the ninth fraction (hexane extract-methanol phase) separated by column chromatography was found to be 63 per cent effective. The purple spot on the TLC of this fraction indicated the presence of a diterpenoid. HPLC of this fraction detected nine compounds with two peaks covering 20.44 and 56.52 per cent areas with retention time of 2.439 and 5.182 min, respectively supporting the TLC results. INTERPRETATION & CONCLUSIONS: The column separated 9 [th] fraction of C. infortunatum extract was found to be effective in killing 63 per cent of adult P. argentipes. Compounds of this fraction need to be evaluated further for identification and characterization of the active molecule by conducting individual bio-assay tests followed by further fractionation and HPLC. Once the structure of the active molecule is identified and validated, it may be synthesized and formulated as a product.