Visual Hallucinations After a Russell's Viper Bite.

Visual hallucinations (VHs) are extremely rare in snakebites. We report a case of Russell's viper bite in an otherwise healthy 55-y-old woman who presented to a hospital in south India with established clinical features of systemic and local envenomation, including coagulation failure, without any neurologic manifestations on admission. She reported simple VH on the third day, which abruptly stopped on the fifth day without any specific medications. Clinical, laboratory, imaging, and electrophysiological studies did not reveal any neuropsychiatric disorders. Including this case, only 5 cases of VH are documented in the literature, 2 following cobra and viper bites and 1 after a sea snake bite. Two cases were reported from Australia and 1 each from the United States, Iran, and India.

Snakebite Mimicking Brain Death: Bedside Clues.

Agarwal et al.1 have successfully managed three cases of snakebites who manifested features similar to brain death but were not true brain dead. Most likely these cases might have gone on to a status of locked-in syndrome (LIS). LIS is a status in which there is complete paralysis of voluntary muscles in all parts of the body except for those that control eye movements. Moreover, this condition makes an individual completely mute and paralyzed in a conscious patient.2 In these individuals, communication may be possible through eye movements. HOW TO CITE THIS ARTICLE: Senthilkumaran S, Balamurugan N, Karthikeyan N, Thirumalaikolundusubramanian P. Snakebite Mimicking Brain Death: Bedside Clues. Indian J Crit Care Med 2021; 25(12):1464.

Oxygen Administration under Surgical Face Mask in COVID-19 Patients: A Game Changer.

COVID-19 is a multifaceted infectious disease. The development of hypoxemic respiratory failure is not uncommon during the course of illness in some of them. The objectives of the present study were to assess the effect of the addition of a surgical face mask while delivering oxygen via nasal cannula in hypoxemic COVID-19 patients and highlight on the advantages and patient's comforts. We prospectively assessed 30 consecutive conscious and hypoxemic COVID-19 patients, requiring oxygen via nasal cannula. The mean PaO2 without and with surgical face mask were 52 (+9) and 83 (-12) mm Hg respectively in the cohort, and the elevation in oxygen saturation was statistically significant (p <0.001). The present results encourage the delivery of oxygen under the surgical face mask in symptomatic COVID-19 patients, as it improves oxygen saturation and prevents aerosol dispersion with no change in PaCO2. The other advantages of this method are a reduction in the total requirement of oxygen per patient, better utilization of scarce resources, and lessening of the expenses incurred for oxygen. HOW TO CITE THIS ARTICLE: Senthilkumaran S, Koushik M, Meenakshisundaram R, Jena NN, Thirumalaikolundusubramanian P. Oxygen Administration under Surgical Face Mask in COVID-19 Patients: A Game Changer. Indian J Crit Care Med 2021;25(11):1286-1287.

Not Touching the Face is Harder Than It Sounds: Need for an Intervention.

In the novel coronavirus (COVID-19) pandemic, preventive medicine has taken center stage, as there is no vaccine or specific antiviral drug regime used to treat patients. Public health authorities and governments are recommending the practice of social distancing and hand hygiene. Hands are a common vector for the transmission of infection, and frequent face touching is extremely common among the public. We developed and applied a new method to prevent face touching which is of utmost importance to break its cycle and subsequent inoculation of the virus through mucous membranes, thus reducing the risk of transmission of COVID-19. HOW TO CITE THIS ARTICLE: Senthilkumaran S, Arathisenthil SV, Meenakshisundaram R, Thirumalaikolundusubramanian P. Not Touching the Face is Harder Than It Sounds: Need for an Intervention. Indian J Crit Care Med 2020;24(8):662-663.

Super Vasmol Poisoning: Dangers of Darker Shade.

How to cite this article: Senthilkumaran S, Jena NN, Thirumalaikolundusubramanian P. Super Vasmol Poisoning: Dangers of Darker Shade. Indian J Crit Care Med 2019;23(Suppl 4):S287-S289.

5-oxoprolinuria (Pyroglutamic Aciduria) and Metabolic Acidosis: Unraveling the Mystery.

A case of high anion gap metabolic acidosis (HAGMA) and high level of 5-oxoprolinuria were noticed in an elderly female of 66 years who had multiple risk/precipitating factors and recovered well with N-acetyl cysteine infusion. This is reported in view of its rarity and to create awareness of this entity among medical students and practicing physicians who handles such cases in emergency room or critical care unit. Moreover they have to remember and investigate the cases of metabolic acidosis for 5-oxoprolinuia especially in susceptible individuals who are on paracetamol with or without other precipitating factors. HOW TO CITE THIS ARTICLE: Senthilkumaran S, Benita F, Jena NN, Sasikumar S, Thirumalaikolundusubramanian P. 5-oxoprolinuria (Pyroglutamic Aciduria) and Metabolic Acidosis: Unraveling the Mystery. Indian J Crit Care Med 2019;23(7):342-343.

Anisocoria: Realities, Recognition, and Remedial Aspects.

The realities, recognition, and remedial aspects of anisocoria at the bedside were highlighted by Adhikari et al.,1 which is almost similar to an earlier report from India.2 Since this condition involves patient safety and clinical assessment, we would like to touch upon 3 Ps (physiological, pathological, and pharmacological) of anisocoria. First and foremost is to elicit a thorough clinical history and then to assess the case in detail which not only rules out injuries, infections, instillation, or ingestion of medicines and instigating mechanisms but also helps rule out various other life-threatening conditions. HOW TO CITE THIS ARTICLE: Senthilkumaran S, Jena NN, Balamurugan N, Florence B, Thirumalaikolundusubramanian P. Anisocoria: Realities, Recognition, and Remedial Aspects. IJCCM 2019;23(11):543.

Russell's Viper Envenomation-Associated Addisonian Crisis.

Snakebite envenomation is an important public health problem in tropical countries. We report a case of bilateral adrenal hemorrhage in a 28-y-old man with Russell's viper bite that occurred in the Sathyamangalam forest range in the Indian state of Tamil Nadu. In this case, a combination of early bite recognition, hospital-based supportive care, corticosteroid therapy, and timely administration of polyvalent antivenom resulted in a favorable clinical outcome.

Numb chin syndrome: A harbinger of tumor progression or relapse.

Numb chin syndrome (NCS) is a rare yet potentially ominous sensory neuropathy in the distribution of the mental or inferior alveolar nerve characterized by unilateral hypoesthesia over the lower lip, chin and occasionally gingival mucosa. Recognizing NCS is clinically important as this may be a subtle sign of occult malignancy progression or heralding the relapses. It may also occur in benign disease, both systemic and dental in origin. Current expert opinion is that patients with NCS without apparent cause should be assumed to have a malignant etiology until proven otherwise Lossos and Siegal (1992) [1]. Here we report a relapse of Non-Hodgkin lymphoma with NCS with no evidence of metastasis.

Reply to Jalink, M.B. Comment on "Senthilkumaran et al. Bilateral Simultaneous Optic Neuritis Following Envenomations by Indian Cobra and Common Krait. Toxins 2022, 14, 805".

We thank the author for showing interest in our article [...].

Pulmonary Thromboembolism following Russell's Viper Bites.

Snakebite envenoming and its resulting complications are serious threats to the health of vulnerable people living in rural areas of developing countries. The knowledge of the heterogeneity of symptoms associated with snakebite envenoming and their management strategies is vital to treat such life-threatening complications to save lives. Russell's viper envenomation induces a diverse range of clinical manifestations from commonly recognised haemotoxic and local effects to several rare conditions that are often not reported. The lack of awareness about these unusual manifestations can affect prompt diagnosis, appropriate therapeutic approaches, and positive outcomes for patients. Here, we report pulmonary thromboembolism that developed in three patients following Russell's viper envenomation and demonstrate their common clinical features and diagnostic and therapeutic approaches used. All patients showed clinical signs of local (oedema) and systemic (blood coagulation disturbances) envenomation, which were treated using polyvalent antivenom. They exhibited elevated heart rates, breathlessness, and reduced oxygen saturation, which are non-specific but core parameters in the diagnosis of pulmonary embolism. The recognition of pulmonary embolism was also achieved by an electrocardiogram, which showed sinus tachycardia and computed tomography and echocardiogram scans further confirmed this condition. Anti-coagulant treatment using low-molecular-weight heparin offered clinical benefits in these patients. In summary, this report reinforces the broad spectrum of previously unreported consequences of Russell's viper envenomation. The constant updating of healthcare professionals and the dissemination of major lessons learned in the clinical management of snakebite envenoming through scientific documentation and educational programs are necessary to mitigate the adverse impacts of venomous snakebites in vulnerable communities.