A case report and overview of organophosphate (OP) poisoning

A case of organophosphate (OP) poisoning who recovered after requiring almost 1000 mg of atropine, 10 gm of PAM and ventilatory support for 7 days is presented here. The overview of organophosphate poisoning and its management is given. With the approach adopted, the mortality reported in the general medicine unit in the central hospital in Nepal is 7.4%. The two important aspects of the management are vigilance of the atropine drip, especially at night, and other physical and psychological support care of the patients.     

Informed consent: is it really understood?

Pre-operative counselling is an important part of the care that we give to our patients undergoing surgery. It ensures that the patients understand about their disease and the procedure that they are undergoing. This study was done with the objective of finding whether or not the patients do actually understand what has been explained to them. This is a prospective study done in the form of a survey with a set questionnaire in two hospitals in Kathmandu namely Patan hospital and Tribhuvan University Teaching Hospital. The patients surveyed were those who were admitted for elective surgery after counselling has been done and consent forms signed. The result showed that the level of understanding was poor in 11%, unsatisfactory in 33%, satisfactory in 37% and excellent in 19%. The level of understanding was affected by the education level of the patients. To conclude, the level of understanding was unsatisfactory in nearly half the patients. Only 19% had optimal understanding. This may reflect the education level of the many of our patients but it clearly points out that the medical profession needs to make more effort to make the patients understand more about their disease process. This can be said to be a reflection of our quality of care.     

Localization of a gene for otosclerosis to chromosome 15q25-q26

Among white adults otosclerosis is the single most common cause of hearing impairment. Although the genetics of this disease are controversial, the majority of studies indicate autosomal dominant inheritance with reduced penetrance. We studied a large multi- generational family in which otosclerosis has been inherited in an autosomal dominant pattern. Five of16 affected persons have surgically confirmed otosclerosis; the remaining nine have a conductive hearing loss but have not undergone corrective surgery. To locate the disease- causing gene we completed genetic linkage analysis using short tandem repeat polymorphisms (STRPs) distributed over the entire genome. Multipoint linkage analysis showed that only one genomic region, on chromosome 15q, generated a lod score >2.0. Additional STRPs were typed in this area, resulting in a lod score of 3.4. STRPs FES (centromeric) and D15S657 (telomeric) flank the 14. 5 cM region that contains an otosclerosis gene.