<p>RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, KARNATAKA BANGALORE ANNEXURE II PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION</p><p>1 1. NAME OF THE Dr. TITTU OOMMEN CANDIDATE PARTHOOR BUNGLOW AND ADDRESS (IN BLOCK LETTERS) KUNNUKUZHY THIRUVANANTHAPURAM KERALA – 695035. 2. NAME OF THE J.J.M. MEDICAL COLLEGE, INSTITUTION DAVANGERE - 577 004. 3. COURSE OF STUDY AND POST GRADUATE (MEDICAL) SUBJECT M.D. – GENERAL MEDICINE 4. DATE OF ADMISSION TO 31-05-2007 COURSE 5. TITLE OF THE TOPIC “BLOOD SUGAR LEVEL, ITS RELEVANCE IN ORGANOPHOSPHOROUS COMPOUND POISONING – A STUDY IN J.J.M. MEDICAL COLLEGE, DAVANGERE” 6. BRIEF RESUME OF THE INTENDED WORK :</p><p>6.1 Need for the study : Acute organophosphorous poisoning is widespread in the developing world and its frequency is increasing.1 India being a predominantly agrarian country pesticides are readily available over the counter. The commonest poisoning in India is with pesticides, most often organosphosphate2. Poisoning is usually by ingestion for suicidal purpose but can occur accidentally also during spraying. Acute organophosphorous poisoning is associated with complication like neurological complications, respiratory paralysis and a high mortality. Therefore early and accurate diagnosis and proper identification of prognostic factors will help in initiating the appropriate treatment so as to bring down the complications and mortality. Random blood sugar level is one of the factors which influences the severity of organophosphorous compound poisoning. Pseudocholinesterase is</p><p>2 also known to be a useful predictor of prognosis in acute organophosphorous poisoning. Thus this study aims at studying the clinical profile of acute organophosphorous poisoning and using random blood sugar levels at admission as a prognostic indicator and to correlate it with pseudocholinesterase levels. </p><p>6.2 Review of literature :</p><p>Acute organophosphorous poisoning is widespread in the developing world and its frequency has increased over the years.1</p><p>The commonest poisoning in India is with pesticides, most often organophosphates because of its easy availability.2</p><p>Organophosphorous poisoning is a serious condition that needs rapid diagnosis and treatment. Since respiratory failure is the major reason for mortality, careful monitoring, appropriate management and early recognition of this complication may decrease the mortality rate.3</p><p>The neurologic features of organophosphorous poisoning can be divided into two types. Type-I which appeared at the time of admission, type II which developed subsequent to admission and not responded to atropine.4</p><p>Transient hyperglycemia and glycosuria are often found in severe organophosphate poisoning, absence of acetone bodies differentiate it from diabetic coma, except for coma in diabetic patients due to hyperosmolarity from excessive blood glucose.5</p><p>Of the 105 patients with orgnaophosphorous poisoning we noticed hyperglycemia in 7% and glycosuria in 14% of patients.6</p><p>Among 37 infants and children studied with organophosphate poisoning and carbamate poisoning 22% patients had hyperglycemia. Complications occurred in 43% patients.7</p><p>3 51 patients with OP and carbamate poisoning admitted in ICU were studied of which glycosuria was noted in 16 patients and hyperglycemia in 6 patients.8</p><p>Plasma choline esterase activity may be reduced upto 50% of normal. Mild, moderate and severe poisoning are associated with 20-50%, 10-20%, less than 10% of normal levels respectively.9</p><p>Butryl cholinesterase / erythrocyte cholinesterase can be assessed more readily and easily and are used as surrogate markers for degree of acetyl cholinesterase inhibition10</p><p>Of the 45 patients studied 66% of our patients had greater than 20% of normal values of pseudocholinesterase through 85% of them had moderate to severe symptoms. Patients with less than 10% of normal values of pseudocholinesterase had poor prognosis.11</p><p>6.3 Objectives of the study : 1. To study the clinical profile in patients who had consumed organophosphorous poison. 2. To predict the prognosis and mortality of organophosphorous compound poisoning based on random blood sugar level and to correlate it with pseudocholinesterase activity.</p><p>4 7. MATERIAL AND METHODS :</p><p>7.1 Source of data : Patients admitted to C.G. Hospital and Bapuji Hospital attached to J.J.M. Medical College, Davangere. </p><p>7.2. Method of collection of data (including sampling procedure if any): A minimum of 50 cases will be selected who are suspected of organophosphorous poisoning with a history of exposure and related clinical findings, over a period of 2 years starting from September 2007 to September 2009. Inclusion criteria :  Patients with age more than 18 years  Patients with history of consumption of organophosphorous compound presenting within 24 hours. Exclusion criteria :  Patients of age less than 18 years  Patients who had consumed alcohol, other poisons, drugs, mixed poisons.  Patients who have history of diabetes mellitus.  Patients who were treated elsewhere. </p><p>Parameters of comparison and statistical methods :  Clinical findings, mortality and ventilator requirement and random blood sugar levels at admission will be used as parameters to assess prognosis of organophosphate poisoning and correlated to pseudocholinesterase levels on admission.  Facts and figures will be represented using appropriate charts and graphs different statistical tools will be used as required. </p><p>5 7.3 Does the study require any investigations or interventions to be conducted on patients or other humans or animals? If so, please describe briefly.</p><p>Yes Random blood sugar at admission Pseudocholinesterase at admission Other relevant investigations when required. </p><p>7.4. Has ethical clearance been obtained from your institution in case of 7.3? Yes</p><p>6 8. LIST OF REFERENCES : </p><p>1. Eddleston M. Patterns and problems of deliberate self poisoning in the developing world. QJM 2000; 93: 715-731.</p><p>2. Wadia SR. Organosphophate poisoning. In: Shah SN, Paul AM, Acharya VN, Bichile SK, Kanad DR, Kuneth SA, et al, editors. API text book of medicine. 7th Edn., Mumbai : The Association of physicians of India; 2003 .p.1271-72.</p><p>3. Sungar M, Guven M. Intensive care management of organophosphate insecticide poisoning. J Crit Care 2001 Aug; 5(4): 211-15.</p><p>4. Wadia RS. The neurology of organophosphate insecticide poisoning newer findings a view point. JAPI 1990; 38: 129-131.</p><p>5. Namba T, Nolte DT, Jackvel G, David Grob. Poisoning due to organophosphates insecticides – Acute and chronic manifestations. The Am J Med 1971 Apr; 50: 475-92.</p><p>6. Hayes MM, Vander Westhuizen NG, Gelfland M. Organophosphate poisoning in Rhodesia. A study of clinical features and management of 105 patients. S Afr Med J 1978; 54: 230-34.</p><p>7. Zweiner RJ, Ginsburg CM. Organophsophate and carbamate poisoning in infants and children. Pediatrics 1988; 81: 121-26.</p><p>8. Shobha TR, Prakash O. Glycosuria in organophosphate and carbamate poisoning. JAPI 2000; 48: 12.</p><p>9. Proudfoot AT, Vale JA. Pesticides. In: Weatherall DJ, Ledingham JGG, Warell DA, editor. Oxford text book of medicine. 3rd Edn., Vol.I, Oxford Medical College; 1996 .p.1120-22.</p><p>7 10. Erdman RA. Insecticides. In: Dart RC, Cararati EM, McGuigan MA, Whyte IM, Dawson AH, Seifert SA, et al, editors. Medical toxicology. 3rd Edn., Philadelphia : Lippincott Williams and Wilkins; 2004 .p.1476-87.</p><p>11. Kuppu Swamy G, Jayarajan A, Kumar SS, Sunder Ram J. Continous infusion of high doses of atropine in the management of organophosphorous compound poisoning. JAPI 1991; 39(2): 190-93.</p><p>8 9. SIGNATURE OF CANDIDATE</p><p>10 REMARKS OF THE This study will help to predict the prognosis GUIDE and mortality of organophosphorous compound poisoning based on random blood sugar level and to correlate it with pseudocholinesterase activity and thus helping in initiating the appropriate treatment bringing down the complications and mortality. 11 NAME & DESIGNATION OF (IN BLOCK LETTERS) Dr. B.G. KARIBASAPPA M.D. 11.1 GUIDE ASSOCIATE PROFESSOR, DEPARTMENT OF GENERAL MEDICINE, J.J.M. MEDICAL COLLEGE, DAVANGERE - 577 004.</p><p>11.2 SIGNATURE</p><p>11.3 CO-GUIDE (IF - - ANY)</p><p>11.4 SIGNATURE</p><p>11.5 HEAD OF DR. P.M. UPASI M.D., DEPARTMENT PROFESSOR AND HEAD, DEPARTMENT OF GENERAL MEDICINE, J.J.M. MEDICAL COLLEGE, DAVANGERE - 577 004.</p><p>11.6 SIGNATURE</p><p>12 REMARKS OF THE CHAIRMAN & PRINCIPAL</p><p>12.2. SIGNATURE.</p><p>9</p>