The responsiveness of renin-angiotensin and kallikrein-kinin systems to furosemide challenge has been investigated in forty-six diabetic patients (34 NIDDM/12 IDDM), subdivided into Group I (uncomplicated DM), Group II (DM with hypertension), Group III (DM with nephropathy), Group IV (DM with hypertension and nephropathy) and a control group of 10 healthy volunteers. Plasma renin activity (PRA) was estimated by radioimmunoassay in blood samples drawn before and 10 min after furosemide administration (0.5 mg/kg i.v.). Urinary kallikrein levels were measured by bioassay using estrogenized rat uterus preparation in 4h urine samples collected before and after the diuretic. Urinary Na+ and K+ were also measured. The basal PRA in diabetics was not significantly different from controls, whereas, urinary kallikrein levels were markedly low in all patients. Both PRA and kallikrein levels increased after furosemide in controls while in diabetics this response was severely blunted. In a subset of Group I, a paradoxical fall in PRA and kallikrein levels was noted after furosemide, an effect similar to that observed in patients with nephropathy (Group III). This response in absence of clinical and biochemical parameters of nephropathy indicates early derangement of renal hemodynamic mechanisms heralding the onset of nephropathy.

Adult↗

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Role and functions of Poisons Information Centre.

The Poisons Information Centre (PIC) is a specialized unit providing information on prevention, early diagnosis and treatment of poisoning and hazard management. Most of the developed and many developing countries have well established poison control centres with poisons information service, patient management facility and analytical laboratory. In India, the National Poisons Information Centre (NPIC) was established in February, 1995 in the Department of Pharmacology at the All India Institute of Medical Sciences, New Delhi. The centre provides toxicological information and advice on the management of poisoned patients adopted to the level of the enquirer. The basis of this service are the databases on poisoning, drug reactions and also the continuous and systematic collection of data from the library. This information service is available round the clock. The PIC has the training responsibility extending to medical and other health professionals and community. The NPIC organized two successive training courses for medical professionals and para professionals at all health levels. Further, NPIC is a participant of INTOX project of IPCS/WHO, receiving regular yearly training on the use of INTOX database. Laboratory service is an essential component of a poisons control programme, providing analytical services on emergency basis to help in diagnosis and management. The NPIC is developing facilities for quick diagnosis of poisoning cases. Toxicovigilance and prevention of poisoning is another major function of PIC. The Centre has prepared manuals and leaflets on prevention and management cards on treatment of various poisonings. Thus the Centre provides a service with considerable health benefits, reducing morbidity and mortality from poisoning and gives significant financial savings to the community.

Child↗

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Accidental pediatric poisoning--a preventable medical emergency.

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Accidents↗

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Poisoning in children: Indian scenario.

The retrospective data on childhood poisoning from eight regional hospitals in India has been reviewed. The demographic features and types of poisonings encountered have been compared. The analysis of the data indicated that pediatric poisonings constituted 0.23-3.3% of the total poisoning. The mortality ranged from 0.64-11.6% with highest being from Shimla. Accidental poisoning was common involving 50-90% of children below 5 years of age and males outnumbered the females. Suicidal poisoning was seen after 13 years of age and was due to drugs and household chemicals. One of the hospitals in Delhi recorded a very high incidence (66.6%) of drug poisoning in children. The drugs consumed belonged to phenothiazines, antiepileptics and antipyretics. Iron poisoning was seen in younger children. Kerosene was one of the causes of accidental poisoning at all hospitals except Shimla and rural Maharashtra were probably wood charcoal is widely used. Pesticide poisoning was more prevalent in Punjab and West Bengal whereas plant poisoning was very common in Shimla. Significant number of snake envenomation has been recorded from rural Maharashtra. Other less common accidental poisonings in children included alcohol, corrosives, heavy metals, rodenticides, detergents and disinfectants. Thus various regions in the country showed some variation in types and frequency of childhood poisoning which could be attributed to different geographical and socio-economic background.

Adolescent↗

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Paracetamol poisoning in children.

Paracetamol (acetaminophen) has become an antipyretic drug of choice. Due to its widespread use, toxicity secondary to overdose has increased in recent years. Children are especially vulnerable to accidental exposure due to non availability of child proof containers in India. The main clinical features of acute toxicity include anorexia, vomiting, abdominal pain, jaundice, hematuria and metabolic acidoses. Diagnosis is based on history and laboratory findings of acidosis and abnormal liver function tests. N-acetylcysteine is the specific antidote. This article reviews in detail the toxicokinetics, pathophysiology, clinical features and management of paracetamol poisoning in children.

Acetaminophen↗

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Serum insulin levels in non-obese, non-diabetic Asian Indians with acute coronary and non-coronary events.

Significant insulin resistance and hyperinsulinemia has been observed to be associated with coronary heart disease in epidemiological studies, particularly so in Asian Indians. This study attempted to investigate if hyperinsulinemia accompanies acute cardiovascular events in Asian Indians, and that it is not a metabolic response to acute stress alone. To test this hypothesis, a case-control study was carried out in a tertiary referral hospital in northern India. Group I (n = 19), consisting of non-diabetic, non-hypertensive, non-obese patients presenting with first episode of acute coronary event (first episode of angina or myocardial infarction) were compared with non-diabetic, non-hypertensive, non-obese patients of group II (n = 21) presenting with non-cardiovascular emergencies (severe abdominal pain e.g. uncomplicated ureteric colic or non-specific intestinal colic. Blood was analysed for glycosylated haemoglobin, fructosamine and insulin levels within 24 hours of the acute event. Elevated serum fructosamine was observed in 11 (57.8%) subjects in group I and 9 (42.9%) in group II (p = NS). Glycosylated haemoglobin was 6.8 +/- 0.1 percent in group I versus 5.9 +/- 0.04 percent in group II (p < 0.01). Three out of 11 subjects in group I and 1/9 subjects in group II having elevated serum fructosamine level also had increased glycosylated haemoglobin level. Five (26.3%) subjects in group I and 2 (9.5%) in group II with elevated glycosylated haemoglobin level were excluded from the analysis as these patients might have been diabetic. Mean serum insulin values were significantly higher in group I (161.3 +/- 8.15 micro IU/mL and 17.5 +/- 1.9 micro IU/mL in groups I and II, respectively; p < 0.001). Eleven (57.8%) subjects in group I had insulin values above 100 uIU/ml. The present study indicates that significant hyperinsulinemia accompanies acute cardiovascular events and it is not an acute response to pain or stress hyperglycemia. Markedly high insulin levels observed in these patients may have a potential role in the pathophysiology of acute coronary event, and may be further studied as a possible prognostic marker.

Case-Control Studies↗

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Profile of acute poisoning cases presenting to health centres and hospitals in Oman.

A simple pro forma was used for a retrospective study of poisoning cases at 45 health institutions in Oman during January-December 2000. No deaths were recorded among 2009 cases of acute poisoning. A quarter of all cases (55.8% of paediatric cases) were children aged 1-4 years. The largest category (59.5%) was animal bites and stings: 25.4% undiagnosed, 19.7% scorpion stings, 7.6% bee, spider or wasp stings and 6.8% snake bites. Next highest (38.5%) was ingestion of substances: 18.2% pharmaceuticals, 8.2% food and 4.7% household products. Most drug-related cases were due to paracetamol. Suicide attempts were recorded for 6.0%. Collection of poisoning data through a central registry system is needed for the implementation and future assessment of prevention programmes.

Accidents↗

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The effect of acute and chronic treatment of verapamil on pressor response to angiotensin II in rats.

The effect of verapamil on pressor response to Angiotensin II (A II) was investigated in rats. The responses to A II (10, 20, 40 ng, iv) was reduced after verapamil (50 and 100 micrograms, iv per rat) in a dose dependent manner. Treatment for 5 day with verapamil (18 mg/100 g/day, po) let to some reduction in basal blood pressure but pressor response to A II was not changed. Treatment for 20 days significantly reduced the basal blood pressure and increased the responsiveness to A II. it is concluded that Ca++ plays a major role in the pressor responses to A II and that chronic treatment with verapamil may reduce basal blood pressure.

Angiotensin II↗

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Effect of Ca++ channel blockers and saralasin on angiotensin II induced contraction in rabbit aortic strip.

To investigate the role of calcium in angiotensin II (A II) induced contractions in rabbit aortic strip, the action of verapamil, nifedipine, cinnarizine and saralasin was studied. The cumulative dose response curves obtained with A II shifted to right with increasing concentrations of all these four agents. The antagonism was noncompetitive. The pD'2 value of saralasin was 8.49 of nifedipine, 8.15 and or verapamil 7.92. Cinnarizine which mainly acts at intracellular site had pD'2 value 5.54. The results indicate that A II induced contractions critically depend on entry of calcium through channels which appear to be closely associated with angiotensin receptors.

Angiotensin II↗

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Poison information services.

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Humans↗

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Hyperinsulinemia in non-obese, non-diabetic subjects with isolated systolic hypertension.

To investigate the inter-relationship of hyperinsulinemia and isolated systolic hypertension, 15 patients with isolated systolic hypertension (Group I) were compared to those having systolic and diastolic hypertension (Group II), and 14 age- and sex-matched controls (Group III). Significantly high triglycerides and total cholesterol were observed in Groups I and II (p < 0.001) and low high-density lipoprotein cholesterol in Group II (p < 0.001), when compared to controls. Significantly high number of patients had impaired glucose tolerance (80%; p = 0.0002 and 60%; p = 0.05) on oral glucose tolerance test in Groups I and II, respectively. Higher blood glucose values were observed in Group I as compared to Group III, at 0, 30, 60 (p < 0.05) and 120 minutes (p < 0.001). Subjects in all the three groups showed fasting normo-insulinemia. At 60 minutes during oral glucose tolerance test, higher insulin levels were seen in Groups I and II as compared to controls (p = NS). Peak insulin levels and area under curve for insulin were higher in Groups I and II as compared to controls (p = NS). The observations of the present study indicate that, similar to systolic and diastolic hypertension, several features of insulin resistance syndrome such as hyperinsulinemia, dyslipidemia and glucose intolerance accompany isolated systolic hypertension.

Adult↗