Background:Organophosphorus poisoning remains an important cause of morbidity and mortality, but no definite parameters have been identified as predictors of outcome. Prediction of morbidity at presentation might help in decision making in places of limited resources like rural settings in developing countries.Materials and Methods:A total of 76 cases were included in this retrospective cohort study. Logged relative risk of requirement of mechanical ventilation and hospital stay >7 days was measured in patients with serum acetylcholinesterase (s. acetylcholinesterase) <1000 versus >1000, presenting in <2 h versus ≥ 2 h after exposure, with Glasgow Coma Scale (GCS) ≤12 versus >12 and in patients with SpO2 <85% versus ≥85% at room air at presentation.Results:S. acetylcholinesterase <1000, time elapsed after ingestion to presentation ≥ 2 h and SpO2 (at room air) at presentation <85% were found to have positive association with requirement of ventilation. GCS ≤ 12 had a significant association with both requirement of ventilation and hospital stay >7 days.Conclusion:S. acetylcholinesterase, SpO2 at room air, GCS, and duration of exposure at presentation can be used to identify the requirement of special care in acute organophosphorus poisoning. This can aid in decision making regarding admission to intensive care unit and referral in the places with limited resources.

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BACKGROUNDUpper gastrointestinal bleeding (UGIB) is one of the common life-threatening emergency hospital admissions. Upper GI Endoscopy is one of the common diagnostic examinations for identifying the cause of bleeding in our as well as in resourcelimited setup which ultimately help a clinician for "resource-sensitive approach". METHODSThis observational study (2015)(2016)(2017) of upper gastrointestinal bleeding (UGIB) was performed at rural based multispecialty teaching hospital in consecutive 115 adult admitted patients (age>12 years) to find out aetiology and clinical as well as esophagogastroduodenoscopic profile. RESULTSOf 115 patients of UGIB, 75 were male (65.21%) and 40 female (34.78%). Mean age was 42.06 ±16.31. 77 (66.95%) presented with hematemesis, 21 (18.26%) with melena, 16 (13.91%) with hematemesis combined with melena and 1 patient presented with hematemesis as well as haematochezia. Endoscopy was able to detect definite cause of UGIB in 104 and in 11 patients it was normal (90.43%). Variceal bleed was commonest and was present in 48 patients, of whom 44 patients (38.26%) had oesophageal, 02 had gastric and other 2 had both oesophageal as well as gastric varices. In non-variceal bleeding, gastric and duodenal ulcer disease was present in 12, esophagitis in 10, oesophageal vascular ectasia in 02, erosive gastritis in 17, gastric malignancy in 04; Mallory Weiss tear in 06, erosive gastritis with duodenitis in 04, and esophagitis with gastric ulcer and duodenal ulcer in 01. 10 of 17 patients who had erosive gastritis gave history of NSAID use. Of the 48 patients who had variceal bleeding, 33 were due to cirrhosis of liver, and 15 were because of non-cirrhotic portal hypertension. Aetiology of 33 patients, who had hospital admission due to cirrhosis of liver related UGIB, was alcohol, hepatitis B, and hepatitis C in 29, 2 and 1 patients respectively. 81 (70.43%) had acute bleeding while 34 (29.56%) had recurrent bleeding. 17 patients were admitted in 2015, 45 in 2016 and 53 in 2017 for UGIB. There was no seasonal variation in incidence of UGIB.

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