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BRIEF REPORT
Year : 2022  |  Volume : 20  |  Issue : 3  |  Page : 168-171

The impact of COVID-19 pandemic on caustic ingestion at a tertiary care center in South India


Department of Gastroenterology, Christian Medical College, Vellore, Tamil Nadu, India

Date of Submission30-Dec-2021
Date of Decision17-Mar-2022
Date of Acceptance23-Mar-2022
Date of Web Publication01-Aug-2022

Correspondence Address:
Dr. Ebby George Simon
Department of Gastroenterology, Christian Medical College, Vellore - 632 004, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/cmi.cmi_118_21

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  Abstract 


Background: The COVID-19 pandemic has had a significant impact on the mental health of individuals which has sometimes led to attempts at deliberate self-harm including the ingestion of caustic substances. This study was aimed to compare the rates of caustic substance ingestion during the pandemic to a similar period in the preceding year at our center. Methodology: We carried out a retrospective analysis, in which patients' details (demographic, clinical, endoscopic, and outcomes) were collected and compared between April 2019 and December 2019 (pre-COVID-19 pandemic) and from April 2020 to December 2020 (during the COVID-19 pandemic). Results: A total of 41 patients were included in this study, 26 (63.4%) in the pandemic period and 15 (36.5%) in the prepandemic period. The majority were female in both the prepandemic (60%) and pandemic periods (53.9%). More adolescents (<18 years of age) were seen in the pandemic period (15.3%) than in the prepandemic period (6.7%). The proportion of patients admitted with caustic substance ingestion in the pandemic period (3.53%) was significantly higher than in the prepandemic period (1.57%) (P = 0.0094). Conclusion: Caustic substance ingestion almost doubled in our center during the COVID-19 pandemic highlighting the burden of mental health issues during a pandemic.

Keywords: Caustic substance, COVID-19 pandemic, endoscopy


How to cite this article:
Rao NV, Simon EG. The impact of COVID-19 pandemic on caustic ingestion at a tertiary care center in South India. Curr Med Issues 2022;20:168-71

How to cite this URL:
Rao NV, Simon EG. The impact of COVID-19 pandemic on caustic ingestion at a tertiary care center in South India. Curr Med Issues [serial online] 2022 [cited 2022 Aug 10];20:168-71. Available from: https://www.cmijournal.org/text.asp?2022/20/3/168/352965




  Introduction Top


The intake of caustic substances as a means of deliberate self-harm is a common cause of hospital admissions in the developing world.[1],[2],[3] Caustic substances are known to cause extensive damage to the gastrointestinal tract leading to perforation and death in the immediate period apart from strictures and esophageal malignancy in the long-term period.

On January 30, 2020, COVID-19 was declared a Public Health Emergency of International Concern by the World Health Organization.[4] The Indian Government launched the first lockdown to cut down the dissemination of the virus on March 24, 2020.[5] A multitude of mental health issues were described during the pandemic including depression, anxiety disorder, deliberate self-harm, and suicides. The most vulnerable groups were those in the pediatric and geriatric age groups, hospital, and other frontline workers as well as those with preexisting mental health problems.[6]

With this background, we aimed to compare the rates of caustic substance ingestion during the pandemic to a similar period in the preceding year.


  Methodology Top


A retrospective study of all patients who had consumed caustic substances and were admitted under the department of gastroenterology at our hospital, a tertiary care center in South India, was conducted. Patients' details were collected through the hospital's computerized data system between April 2019 and December 2019 (pre-COVID-19) and from April 2020 to December 2020 (during the COVID-19 pandemic).

Upper gastrointestinal endoscopy was performed within a day of consumption of the caustic substance, and endoscopic findings were classified using the Zargar classification.[7]

Data consisting of demographics, caustic agent ingested, intent, symptoms and signs, endoscopic findings, and outcomes were collected and compared between the prepandemic and pandemic periods. Statistical analysis was performed using the Chi-square test or Fisher's exact test, as applicable for categorical data. The data were analyzed with SPSS v. 21.0 data (Statistical Package for the Social Sciences, SPSS Inc., Chicago, IL, USA). A P < 0.05 was taken to be statistically significant.

This study was approved by our Institutional Review Board (Ref: IRB: 14286 [Retro] dated September 29, 2021), and being a retrospective study, there was waiver of consent.


  Results Top


We were able to include 41 patients in this study, 26 (63.4%) of them in the pandemic period and 15 (36.5%) in the prepandemic period. The total number of admissions to the department of gastroenterology during the pandemic and prepandemic periods was 736 and 953 patients, respectively. The proportion of patients admitted with caustic substance ingestion in the pandemic period (3.53%) was significantly higher than in prepandemic period (1.57%) (P = 0.0094).

[Table 1] depicts the comparison between various demographic, clinical, and endoscopic characteristics in the two groups. Majority were females in both the prepandemic (60%) and pandemic periods (53.9%). More adolescents (<18 years of age) were seen in the pandemic period (15.3%) than in the prepandemic period (6.6%), although the difference was not statistically significant. In both groups, acid predominantly toilet cleaner was the most common agent ingested. Deliberate self-harm was the major cause of ingestion in both groups. In the pandemic period, 23% had an intake of multiple suicidal agents (such as alcohol, rat killer poison, and medication overdose) in addition to caustic ingestion compared to none in the prepandemic period. More patients in the pandemic period reported pharyngeal and laryngeal edema (46.1% and 34.6%, respectively) compared to the prepandemic period (13.3% and 6.6%, respectively). However, less patients in the pandemic period reported severe esophageal and gastric injury (61.6% and 46.2%, respectively) compared to the prepandemic period (73.4% and 80%, respectively). The rates of various outcomes (nasogastric tube placement, need for feeding jejunostomy, and the length of stay) were also similar in both groups. However, there were two patients who needed mechanical ventilatory support and death was reported in the pandemic period compared to none in the prepandemic period.
Table 1: Comparison of the demographic, clinical, and endoscopic findings of caustic ingestion between the prepandemic and pandemic groups

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  Discussion Top


The COVID-19 pandemic has had a serious effect on the mental health of individuals.[8] The sudden announcement of the nationwide lockdown on March 24, 2020, led to an extreme change in the daily routine of many people, thereby adversely affecting their social, economic, and mental health.[6],[8],[9]

As far as we are aware, this is the first study from India looking at the impact of caustic ingestion during the pandemic. We found that the rate of caustic substance ingestion during the pandemic period was significantly more than the previous year. A previous study by Bharath Kumar et al. reported 112 patients with caustic ingestion over 7 years (2008–2015) with an average of 16 cases per year.[10] Our study had similar numbers in the prepandemic period but the rates almost doubled during the pandemic period. Demographic data showed a female preponderance in both groups, an observation also made by Bharath Kumar et al. On the contrary, previous Indian studies had found a male predominance.[11],[12] Simha et al. observed that females experienced more mental strain compared to males during the pandemic.[13] Some of the possible reasons for this finding could be lack of financial independence, increase in intrafamilial conflicts due to socioeconomic causes, and domestic violence during lockdowns.

The previous studies had shown acid, mainly toilet cleaners (sulfuric or hydrochloric acid), as the chief caustic substance ingested, which was similar to our study.[14],[15] The reasons cited for acid being the chief substance ingested were the ease of availability and that they were cheap when compared to caustic soda which is commonly used in western countries.[16] However, 23% of our patients gave a history of ingesting multiple suicidal agents in the pandemic indicating the degree of suicidal intent in this period.

Children, elderly people, frontline workers, and those with prior psychiatric conditions have been observed to run the risk of major mental health issues during the pandemic.[6] We observed a greater number of people <18 years of age (15.3%) who consumed caustic substances unlike in the prepandemic period (6.7%). All our patients who belonged to this age group showed features of suicidal intent, highlighting the effect of the pandemic on mental health.

Thongchuam et al. also reported the impact of the pandemic on caustic ingestion from a single center in Thailand. They noted an increasing trend in caustic ingestion and more severe gastric injury in the pandemic period than in the prepandemic period.[17] In our study, we found increased frequency of patients with pharyngeal and laryngeal edema with decreasing frequency of severe esophageal and gastric injury (Zargar grade >IIB) during the pandemic compared to the previous year. Corrosive injuries with suicidal intent are commonly associated with more severe oropharyngeal injuries because of possible reluctant ingestion, whereas in accidental injuries, there is the consumption of larger volumes associated with more severe gastric injuries.[16]

Limitations to this study include its retrospective nature, small sample size, being confined to a single tertiary care center, and the influence of referral practices in a pandemic.


  Conclusion Top


The rate of admissions for caustic substance ingestion almost doubled in our center with the advent of the COVID-19 pandemic. This indirectly highlights the burden of mental health issues during a pandemic and the need for a more robust system for identification and supporting the vulnerable population.

Research quality and ethics statement

All authors of this manuscript declare that this scientific study is in compliance with standard reporting guidelines set forth by the EQUATOR Network. The authors ratify that this study required institutional review board/ethics committee review, and hence, prior approval was obtained (Ref: IRB: 14286 [Retro] dated September 29, 2021). We also declare that we did not plagiarize the contents of this manuscript and have performed a plagiarism check.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Wijeratne T, Ratnatunga C, Dharrmapala A, Samarasinghe T. Corrosive acid injury of the stomach. Ceylon Med J 2015;60:25-7.  Back to cited text no. 1
    
2.
Benjamin RN, David T, Iyadurai R, Jacob KS. Suicidal nonorganophosphate poisoning in a tertiary hospital in South India: Nature, prevalence, risk factors. Indian J Psychol Med 2018;40:47-51.  Back to cited text no. 2
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3.
Rodríguez Vargas BO, Monge Salgado E, Montes Teves P, Salazar Ventura S, Guzmán Calderón E. Caustics injuries in the upper gastrointestinal tract: Clinical and endoscopic features. Rev Gastroenterol Peru 2016;36:135-42.  Back to cited text no. 3
    
4.
Wilder-Smith A, Osman S. Public health emergencies of international concern: A historic overview. J Travel Med 2020;27:taaa227.  Back to cited text no. 4
    
5.
Ahmed S, Khaium MO, Tazmeem F. COVID-19 lockdown in India triggers a rapid rise in suicides due to the alcohol withdrawal symptoms: Evidence from media reports. Int J Soc Psychiatry 2020;66:827-9.  Back to cited text no. 5
    
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Roy A, Singh AK, Mishra S, Chinnadurai A, Mitra A, Bakshi O. Mental health implications of COVID-19 pandemic and its response in India. Int J Soc Psychiatry 2021;67:587-600.  Back to cited text no. 6
    
7.
Zargar SA, Kochhar R, Mehta S, Mehta SK. The role of fiberoptic endoscopy in the management of corrosive ingestion and modified endoscopic classification of burns. Gastrointest Endosc 1991;37:165-9.  Back to cited text no. 7
    
8.
Violant-Holz V, Gallego-Jiménez MG, González-González CS, Muñoz-Violant S, Rodríguez MJ, Sansano-Nadal O, et al. Psychological health and physical activity levels during the COVID-19 pandemic: A systematic review. Int J Environ Res Public Health 2020;17:9419.  Back to cited text no. 8
    
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Dubey S, Biswas P, Ghosh R, Chatterjee S, Dubey MJ, Chatterjee S, et al. Psychosocial impact of COVID-19. Diabetes Metab Syndr 2020;14:779-88.  Back to cited text no. 9
    
10.
Bharath Kumar C, Chowdhury SD, Ghatak SK, Sreekar D, Kurien RT, David D, et al. Immediate and long-term outcome of corrosive ingestion. Indian J Gastroenterol 2019;38:356-61.  Back to cited text no. 10
    
11.
Ananthakrishnan N, Parthasarathy G, Kate V. Chronic corrosive injuries of the stomach – A single unit experience of 109 patients over thirty years. World J Surg 2010;34:758-64.  Back to cited text no. 11
    
12.
Gupta NM, Gupta R. Transhiatal esophageal resection for corrosive injury. Ann Surg 2004;239:359-63.  Back to cited text no. 12
    
13.
Simha A, Prasad R, Ahmed S, Rao NP. Effect of gender and clinical-financial vulnerability on mental distress due to COVID-19. Arch Womens Ment Health 2020;23:775-7.  Back to cited text no. 13
    
14.
Lahoti D, Broor SL. Corrosive injury to the upper gastrointestinal tract. Indian J Gastroenterol 1993;12:135-41.  Back to cited text no. 14
    
15.
Nagi B, Kochhar R, Thapa BR, Singh K. Radiological spectrum of late sequelae of corrosive injury to upper gastrointestinal tract. A pictorial review. Acta Radiol 2004;45:7-12.  Back to cited text no. 15
    
16.
Lakshmi CP, Vijayahari R, Kate V, Ananthakrishnan N. A hospital-based epidemiological study of corrosive alimentary injuries with particular reference to the Indian experience. Natl Med J India 2013;26:31-6.  Back to cited text no. 16
    
17.
Thongchuam C, Mahawongkajit P, Kanlerd A. The effect of the COVID-19 on corrosive ingestion in Thailand. Open Access Emerg Med 2021;13:299-304.  Back to cited text no. 17
    



 
 
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