
==== Front
J Family Med Prim Care
J Family Med Prim Care
JFMPC
J Family Med Prim Care
Journal of Family Medicine and Primary Care
2249-4863
2278-7135
Wolters Kluwer - Medknow India

JFMPC-13-3457
10.4103/jfmpc.jfmpc_1653_23
Letter to Editor
Analysis of acute poisoning cases at a tertiary care hospital
Gupta Harish
Department of Medicine, King George’s Medical University, Lucknow, Uttar Pradesh, India
Address for correspondence: Dr. Harish Gupta, Department of Medicine, King George’s Medical University, Shahmina Road, Chowk, Lucknow, Uttar Pradesh - 226 003, India. E-mail: harishgupta@kgmcindia.edu, Twitter: @Dr_HarishGupta
8 2024
26 7 2024
13 8 34573458
08 10 2023
01 3 2024
07 3 2024
Copyright: © 2024 Journal of Family Medicine and Primary Care
2024
https://creativecommons.org/licenses/by-nc-sa/4.0/ This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.
==== Body
pmc“Pesticide regulation is an under-used but highly effective strategy to prevent #suicide. The high toxicity of many pesticides leads to death, particularly in situations where there is no antidote or where there are no medical facilities nearby.” – World Health Organization, Sep 10, 2019.[1]

Dear Editor,

Aggarwal et al.[2] made a study of the pattern and outcome of acute poisoning cases at (a) tertiary care hospital in north India in their original article published in the Journal, September 2023 issue. In the study, the investigators went through records of more than 400 patients, sifted the case sheets, compiled the data in the form of many tables, and presented their observations in an easy-to-understand manner. The study provides an insight into the multi-factorial complexities, and challenges intertwined therein and profiles the patients getting admitted at the teaching hospital. I am grateful to the authors for observing due diligence while preparing the results and then explaining behind-the-scenes demography.

Nevertheless, while going through the Results, I had certain reservations too which I want to share with them. They found that close to three-fifths (60%) patients of the clinical cases were males and the rest were females. Hence, more number of males indicate (possibly) a high degree of stress on academic, financial, and emotional fronts to achieve targets. But the fact of the matter is that nowadays both genders are of the race in academics. Gross enrolment data for both genders, as per statistics provided by the Government of India, indicate that as many girls are in schools in our era as boys.[3] Both genders have aspirations for a brighter future and have been making efforts to reach the sky in our times. While recounting these facts, it is difficult to surmise that males are under more academic stress than females in our society.

Contrarily, we need to realise the possibility of selection bias in the observational study.[4] Subjects in the study do not represent the general population but are carved out from that cohort who succeeded in reaching the tertiary care hospital. Nowadays, public ambulance services ferry patients from their homes to hospitals.[5] As males are more likely to get attention from close family-members and immediate neighbourhood during crisis times in a patriarchal society, they get overrepresented in the indoor lot.[6] A few years ago when the (then) Director of AIIMS, New Delhi, calculated the total number of patients attending its OPD and then estimated sex ratio, they found more males than females.[7] Males have invisible advantages in our society[8] which they leverage when they get ill and that undercurrent may distort our findings.

Another observation of the authors is that poison consumption is more prevalent in rural populations. The inequality is found to be in the 80:20 ratio. One of the reasons for the observation may be that tertiary care teaching hospitals get complicated cases from remote and rural areas. As those areas usually do not have well-functioning hospitals[9] providing round-the-clock patient-care-services; they are brought, rather, referred there. Although now with one medical college per district scheme, things are changing[10] − hopefully for the better. Resultantly, awareness of the dynamics of patient-transport is as important as to what happens when s/he gets admitted and afterward.

A point that needs to be underscored is that tertiary care hospitals serve as a beacon of hope for many. When someone consumes an obnoxious chemical in a village and s/he does not get relief at a local health center, his attendants make every possible attempt to make him reach a center capable enough to handle complications. We need to have the information in mind when interpreting data of their management later on. In one of the paragraphs, the authors mention that few studies have shown that the urban population forms the majority of cases. Here reference number 22 is cited. When one goes through it, one finds that the study was conducted at a private institution. As profit-oriented private healthcare facilities are rarely interested in managing complicated poor patients, they may throw up weird and twisted results. This point also needs to have a counterview as well, as exceptions to the rule occur in the private sector too.

There is another interesting observation under the heading of ‘duration of hospital stay’. Here among other points, the authors discover that patients of aluminium phosphide/Celphos stay there relatively for shorter duration. But the fact should not make us guess its lethality. Table 7 shows that the chemical has the highest case fatality rate. In the last paragraph of the Results, they highlight that the requirement for a ventilator (is) most commonly associated with aluminium phosphide (poison). When we connect the dots, we find that patients of the presentation either rapidly deteriorate, need life-supportive therapies, and then either do not survive or make it to the other side, that is, survive and are then discharged. We need to teach our residents such fundamental principles together to have a better grasp of the happenings unfolding indoors in a medical-ward.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.
==== Refs
1 WHO, on X (formerly Twitter) Available from: https://x.com/WHO/status/1171324768001372160?s=20 [Last accessed on 2023 Oct 08]
2 Aggarwal N Sawlani KK Chaudhary SC Usman K Dandu H Atam V Study of pattern and outcome of acute poisoning cases at tertiary care hospital in North India J Family Med Prim Care 2023 12 2047 52 38024899
3 Ministry of Education. GER improved in 2021-22 at primary, upper primary, and higher secondary levels of school education compared to 2020-21, posted on Nov 3 2022 Available from: https://www.pib.gov.in/PressReleasePage.aspx?PRID=1873307 [Last accessed on 2023 Oct 08]
4 Tripepi G Jager KJ Dekker FW Zoccali C Selection bias and information bias in clinical research Nephron Clin Pract 2010 115 c94 9 20407272
5 National Health Mission. EMTS Cell- 108 & 102 services Available from: https://upnrhm.gov.in/Home/EMTSCell108 [Last accessed on 2023 Oct 08]
6 Information and Public Relation Department. 250 AMBULANCES OF ADVANCE LIFE SUPPORT SERVICE, 2,270 OF NATIONAL AMBULANCE SERVICE AND 2,200 UNDER 108 SERVICE ARE OPERATED IN THE STATE: CHIEF MINISTER Available from: https://information.up.gov.in/en/250-ambulances-of-advance-life-support-service-2270-of-national-ambulance-service-and-2200-under-108-service-are-operated-in-the-state-chief-minister [Last accessed on 2023 Oct 08]
7 Kapoor M Agrawal D Ravi S Roy A Subramanian SV Guleria R Missing female patients: An observational analysis of sex ratio among outpatients in a referral tertiary care public hospital in India BMJ Open 2019 9 e026850
8 Jha A Charts that capture the persisting problem of patriarchy in India Hindustan Times. Mar 3 2022 Available from: https://www.hindustantimes.com/india-news/charts-that-capture-the-persisting-problem-of-patriarchy-in-india-101646242872415.html [Last accessed on 2023 Oct 08]
9 Sabde Y Diwan V Mahadik VK Parashar V Negandhi H Trushna T Medical schools in India: Pattern of establishment and impact on public health - A Geographic Information System (GIS) based exploratory study BMC Public Health 2020 20 755 32448195
10 Kumar R District medical colleges in India – Addressing the rural health care needs J Surg Spec Rural Pract 2022 3 45 6
