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PubMed1989

Electrophysiological studies of the eye, peripheral nerves and muscles in epidemic dropsy.

The involvement of the neurological system in epidemic dropsy is controversial. During two outbreaks of epidemic dropsy, detailed neurological and ocular examinations and electrophysiological studies of peripheral nerves and muscles (motor nerve conduction velocities, sensory nerve latencies and electromyography) and eye (electroretinogram and visually evoked cortical responses) were therefore undertaken. Amongst the 239 subjects examined, burning sensation and tingling paraesthesias of feet were reported by 42.3 and 35.6%, respectively; but none had any objective evidence of central or peripheral nervous system involvement. Electrophysiological studies of peripheral nerves and muscles (10 cases with subjective manifestations) and eyes (24 eyes of 12 patients hospitalized for control of glaucoma) were essentially normal. It is concluded that Argemone mexicana or its toxins do not have any significant effect on the nervous system.

Adolescent↗
PubMed1987

Optic disc vasculitis in epidemic dropsy.

During an outbreak of epidemic dropsy in Delhi, 233 patients were studied. Retinal changes including venous dilatation and tortuosity, haemorrhages and disc oedema were observed. A clinical picture compatible with type I optic disc vasculitis was seen in 13 eyes and that of type II in 3 eyes. Fluorescein angiography was carried out in 23 randomly selected cases. Relevant angiographic findings included dilated and tortuous retinal veins, prominent vascular staining, blocked fluorescence, microaneurysms, disc oedema and peripapillary dye spillage. Presence of positive angiographic findings correlated well with the severity of the systemic disease, glaucoma, however, revealed no correlation. Papillophlebitis, a new ocular manifestation of Argemone mexicana oil toxicity, as also the fluorescein angiographic picture in epidemic dropsy is being reported for the first time in the literature.

Disease Outbreaks↗
PubMed2001

A two-centre collaborative study on clinico-epidemiological profile of a recent outbreak of epidemic dropsy in New Delhi (India) with special emphasis on its cardiac manifestations in pediatric patients.

A hundred and six clinically diagnosed cases of epidemic dropsy, admitted in June to August 1998 to the P-III unit of RML Hospital and the Department of Pediatrics, Safdarjang Hospital, were studied. All of them consumed mustard oil contaminated with Argemona mexicana, confirmed by ferric chloride and nitric acid tests. No specific sex predilection was seen. No child was affected below the age of 3 years. Pedal edema and reddish hyperpigmentation were the most consistent findings (100 per cent). Frank cardiac failure was seen in only 24 (22.64 per cent), yet persistent tachycardia was alarmingly high (104/106, i.e. 98.4 per cent). Notably ECG showed prolonged Q-T interval in 24 children (22.64 per cent), unrelated to serum Ca2+ level in patients with congestive cardiac failure (CCF). Color Doppler echocardiography showed biventricular dilatation in all the 24 patients with CCF. Wide pulse pressure was recorded in two patients only. Mortality occurred in only two patients (1.89 per cent). Eye involvement was a late finding. All those who survived (i.e. 104/106) recovered completely, except two patients who were left with sarcoid-like changes of skin telangiectasia.

Disease Outbreaks↗
PubMed1999

Epidemic dropsy in India.

Epidemic dropsy is a clinical state resulting from use of edible oils adulterated with Argemone mexicana oil. Sanguinarine and dehydrosanguinarine are two major toxic alkaloids of Argemone oil, which cause widespread capillary dilatation, proliferation and increased capillary permeability. Leakage of the protein-rich plasma component into the extracellular compartment leads to the formation of oedema. The haemodynamic consequences of this vascular dilatation and permeability lead to a state of relative hypovolemia with a constant stimulus for fluid and salt conservation by the kidneys. Illness begins with gastroenteric symptoms followed by cutaneous erythema and pigmentation. Respiratory symptoms such as cough, shortness of breath and orthopnoea progressing to frank right-sided congestive cardiac failure are seen. Mild to moderate anaemia, hypoproteinaemia, mild to moderate renal azotemia, retinal haemorrhages, and glaucoma are common manifestations. There is no specific therapy. Removal of the adulterated oil and symptomatic treatment of congestive cardiac failure and respiratory symptoms, along with administration of antioxidants and multivitamins, remain the mainstay of treatment. Selective cultivation of yellow mustard, strict enforcement of the Indian Food Adulteration Act, and exemplary punishment to unscrupulous traders are the main preventive measures.

Adolescent↗
PubMed1976

Dropsy of the fetal sacs in mares: induced and spontaneous abortion.

Eight cases of severe dropsy of the fetal sacs have been observed in mares. All were in multiparous mares whose ages ranged from five to 20 years and who were 7 1/2 to 10 3/4 months pregnant. Abortion started spontaneously in four cases and had to be induced in the remaining four by manual dilation of the cervix, rupture of the tough allantochorion and the siphoning off of 120 to 220 litres of allantoic fluid. The amnion was normal. Dystocia, due to uterine inertia, occurred in all eight cases, one hydrocephalic fetus needing fetotomy. All fetuses were alive at delivery although four were teratologically deformed and two were markedly underdeveloped. None survived. Retention of a somewhat oedematous placenta occurred in six cases. Microscopic examination of the placenta showed some evidence of degeneration, but none of inflammatory change. One mare died, seven recovered rapidly. One mare was served again and gave birth to a living foal. Special care needs to be given to pre- and post-operative shock, retained placenta and delayed involution.

Abortion, Induced↗
PubMedDate not supplied

Field investigaton of an outbreak of epidemic dropsy in eastern Nepal.

About 17 cases with clinical syndrome suggestive of epidemic dropsy attended to the B P Koirala Institute of Health Sciences, Dharan, for treatment. These cases were from three villages of Saptari district in eastern Nepal. Some of the mustard oil samples were tested positive with Nitric acid test. In the wake of this, an extensive field investigation was conducted covering a wider area in these villages.

Adolescent↗
PubMed1991

Epidemic dropsy in Andhra Pradesh due to contaminated ghee.

An outbreak of epidemic dropsy in Andhra Pradesh was studied during August to September 1987. Thirty cases from 6 families were identified and examined. Ghee and one oil sample were found to be contaminated with the toxic compound sanguinarine. The affected families had purchased ghee from one vendor. The epidemic ended after alerting the villagers of the contaminated ghee, and stopping its further use.

Alkaloids↗
PubMed1989

From dropsy to Bright's disease to end-stage renal disease.

Clinical concepts--labels placed on categories of sickness--are essential to both the physician's and the patient's understanding of a disease. The changing use of labels in renal medicine reflected how physicians and others thought about kidney disease, each new label suggesting increasing complexity in the encounter of renal patient and physician. While dropsy referred to symptoms easily perceived by the patient as well as the physician, Bright's disease focused mainly on microscopic pathology invisible to the patient. Most removed from palpable symptoms is end-stage renal disease, a diagnosis often uncovered by autoanalyzer, defined by the need for dialysis, and formally bestowed by government. This process of definition and redefinition demands the attention of scholars because it reveals much about the evolution of medical thought and practice.

Edema↗
PubMed1994

Epidemic dropsy in Trans Yamuma areas of Delhi and U.P.

Thirty patients of epidemic dropsy from seven families scattered in different areas of East Delhi and UP were studied. The age group of the affected individuals varied from 2 years to 55 years. Argemone oil contamination was found in mustard oil used for cooking. Sanguinarine was detected in all suspected oil samples. Pitting edema of legs was the most consistent feature present in all cases. Other prominent features like local erythema and tenderness were present in 80% and 70% cases, respectively. In contrast to earlier epidemics, two striking features were presence of persistent tachycardia without any pyrexia in all the cases and absence of any ocular problems. There was one death due to congestive heart failure and partial recovery in all others in a 2 months follow up.

Adolescent↗