BACKGROUND: Bottle gourd (Lagenaria siceraria) is popularly known as lauki, ghia or dudhi in India. Its consumption is advocated by traditional medicine healers for controlling diabetes mellitus, hypertension, liver diseases, weight loss and other diseases. However, in last few years there have been reports of suspected toxicity due to consumption of its juice leading to severe vomiting and upper gastrointestinal bleeding. As emergency physicians we need to be aware of this very rare poisoning specially in India. METHODS: We present a case of a 52-year-old woman who presented with multiple episodes of hematemesis and shock to the emergency department (ED) after consuming bottle gourd juice. The patient was resuscitated and stabilized with fluids, proton pump inhibitors and antiemetics and shifted to the intensive care unit (ICU) under the care of a gastroenterology team for urgent endoscopy and further management. RESULTS: The patient received intravenous fluids, antibiotics, antiemetics, and antacids and underwent upper gastroenterologic endoscopy during the hospitalization. She was discharged in a stable condition 4 days later. CONCLUSIONS: As a member of the Cucurbitaceae family, bottle gourd contains toxic tetracyclic triterpenoid compounds called cucurbitacins which are responsible for the bitter taste and toxicity. There is no known antidote for this toxicity, and clinicians treat such patients symptomatically only. It is important to educate the public about the harmful effects of this potentially life-threatening toxicity.

BACKGROUND: Bombing is a unique incident which produces unique patterns, multiple and occult injuries. Death often is a result of combined blast, ballistic and thermal effect injuries. Various natures of injury, self referrals and arrival by private transportation may lead to "wrong triage" in the emergency department. In India there has been an increase in incidence of bombing in the last 15 years. There is no documented triage tool from the National Disaster Management Authority of India for Bombings. We have tried to develop an ideal bombing specific triage tool which will guide the right patients to the right place at the right time and save more lives. METHODS: There are three methods of studying the triage tool: 1) real disaster; 2) mock drill; 3) table top exercise. In this study, a table top exercise method was selected. There are two groups, each consisting of an emergency physician, a nurse and a paramedic. RESULTS: By using the proportion test, we found that correct triaging was significantly different (P=0.005) in proportion between the two groups: group B (80％) with triage tool performed better in triaging the bomb blast victims than group A (50％) without the bombing specific triage tool performed. CONCLUSION: Development of bombing specific triage tool can reduce under triaging.

OBJECTIVE: The purpose of this meta-analysis was to explore the effect of corticosteroids on atrial fibrillation (AF) following catheter ablation. METHODS: We searched PubMed, Embase, and the Cochrane Central Register of Controlled Trials for published articles describing the effect of corticosteroids in preventing AF recurrence after catheter ablation. Data on study and patient were extracted. Risk ratios (RRs) and 95% confidence intervals (CIs) were calculated by use of a random-effect model, and P values of <0.05 were considered significant. RESULTS: Two randomized controlled trials (RCTs) and three cohort studies involving 846 patients were included in this meta-analysis. Within one month of catheter ablation, corticosteroid use was associated with a declined risk of recurrence of AF in RCT (RR 0.57, 95% CI 0.39 to 0.85, P=0.005), but without significant effect in cohort studies (RR 1.01, 95% CI 0.79 to 1.30, P=0.94). After three months of catheter ablation, corticosteroids did not have a significant effect in the prevention of late recurrence of AF in either RCT (RR 0.78, 95% CI 0.38 to 1.59, P=0.49) or cohort studies (RR 0.96, 95% CI 0.70 to 1.31, P=0.78). CONCLUSIONS Our meta-analysis suggested that periprocedural administration of corticosteroids of catheter ablation was associated with reduction of early but not late recurrence of AF.
Adrenal Cortex Hormones/therapeutic use* ; Aged ; Atrial Fibrillation/drug therapy* ; Catheter Ablation/adverse effects* ; Cohort Studies ; Humans ; Middle Aged ; Odds Ratio ; Randomized Controlled Trials as Topic ; Recurrence ; Risk Factors ; Treatment Outcome