ABSTRACT
This is a case of Kounis syndrome with chest tightness, lightheadedness, unconsciousness, and features of shock following multiple wasp stings. Despite cardiopulmonary resuscitation and management of allergic and cardiac symptoms, the patient died. Kounis syndrome should be suspected when a patient presents with allergic symptoms and acute coronary syndrome.
ABSTRACT
BACKGROUND: The growing concern over pesticide use has been linked to self-harm and suicide especially in agricultural countries like Nepal. Pesticides like organophosphorus and aluminum phosphide cause the majority of deaths. Although organophosphorus poisoning is common means for suicide, Aluminum phosphide poisoning is also encountered occasionally. Our case series aims to look after the intent of poisoning and the outcome of the patients following Aluminum phosphide poisoning. METHODS: This hospital record-based study includes Aluminum phosphide poisoning patients presenting to the emergency department of Scheer Memorial Adventist Hospital from first January 2017 to 31st December 2020. Data were analyzed using SPSS version-22. RESULTS: Out of 25 total poisoning cases, most of them were female (60%) and married (56%). The case fatality rate was 84% among which 20% cases were brought dead while 64% died in the hospital. All poisoning cases were suicidal in intent. CONCLUSIONS: Herein we report a case series on 25 Aluminum phosphide poisoning cases with high case fatality rate and all cases being suicidal in intent.
Subject(s)
Pesticides , Phosphines , Aluminum Compounds , Female , Humans , Male , Nepal/epidemiology , Phosphines/analysisABSTRACT
Aluminum phosphide (ALP) is a highly toxic compound most commonly available as Celphos in Nepal. Suicidal ingestion is common in developing countries like Nepal as it is easily available and has a high mortality rate. Farmers to protect crops from rodents and pests use it. Here we present a case of a 24-year-old female with suicidal ingestion of one and a half-tablet of ALP presented with abdominal pain and vomiting. The patient developed metabolic acidosis, hyperkalemia, acute respiratory distress, and hypotension during the Intensive Care Unit stay. Supportive treatment with gastric lavage (coconut oil), intravenous magnesium sulfate, sodium-bicarbonate infusion, adequate vasopressor and close monitoring of hemodynamic parameters helped in the survival of the patient (AU)
El fosfuro de aluminio (ALP) es un compuesto altamente tóxico más comúnmente disponible como Celphos en Nepal. La ingestión suicida es común en países en desarrollo como Nepal, ya que está fácilmente disponible, teniendo una alta tasa de mortalidad. Los agricultores lo utilizan para proteger los cultivos de roedores y plagas. Aquí presentamos el caso de una mujer de 24 años con ingesta suicida de una tableta y media de ALP que presentó dolor abdominal y vómitos. La paciente desarrolló acidosis metabólica, hiperpotasemia, dificultad respiratoria aguda e hipotensión durante su estancia en la Unidad de Cuidados Intensivos. El tratamiento de soporte con lavado gástrico (aceite de coco), sulfato de magnesio intravenoso, infusión de bicarbonato de sodio, vasopresor adecuado y monitoreo estrecho de los parámetros hemodinámicos ayudaron a la supervivencia del paciente (AU)
Subject(s)
Humans , Female , Young Adult , Suicide, Attempted , Aluminum Compounds/toxicity , Poisoning/diagnosis , Poisoning/therapy , Acidosis/chemically induced , Acidosis/therapyABSTRACT
Hypertriglyceridemia led acute pancreatitis secreted exudative fluid tacked to the right iliac fossa may cause irritation of retroperitoneum leading to acute periappendicular inflammation and acute appendicitis.
ABSTRACT
Nepal started the COVID-19 vaccination on 27 January 2021 with AstraZeneca/Oxford Coronavirus Disease-19 AZD1222 (Covishield) vaccine to control the Coronavirus disease pandemic. The vaccine has a good safety profile, with cardiovascular complications being rare. Herein we report a rare case of cardiovascular complication following Covishield vaccination in a 33 years old female who had dizziness and elevated blood pressure immediately following vaccination and abnormal electrocardiogram showing T wave inversions followed by left bundle branch block. The patient was kept on observation, following which the blood pressure and electrocardiogram changes were normal by seven days. This cardiovascular complication following the vaccination demands further investigation into the adverse event of the vaccine. However, since the benefit of the vaccine outweighs the risk, World Health Organization has recommended the continuity of the vaccine as of now.
Subject(s)
COVID-19 Vaccines , COVID-19 , Adult , ChAdOx1 nCoV-19 , Female , Humans , Nepal , SARS-CoV-2 , VaccinationABSTRACT
Background Poisoning has become a major public health problem, with the intent in most cases being self-harm and commit suicide. This study highlights the psychological and clinical-epidemiological profile of patients visiting Scheer Memorial Adventist Hospital after poisoning. Methods This retrospective record-based study was done among poisoning patients of a hospital in Nepal from 1st January 2018 to 31st December 2020. Data were analyzed using STATA version-15. Results Out of 134 total poisoning cases, 71 had consumed organophosphate compounds. The majority of the cases were female (59.2% in organophosphate groups, 69.8% in non-organophosphate groups). The circumstances of poisoning were mostly suicidal (95.8% in organophosphate groups, 90.5% in non-organophosphate groups) and the reasons for this being mostly family disputes. Organophosphate groups had 8.41 times higher odds of having complications when compared to non-organophosphorus compounds. Conclusions The majority of the poisoning cases were suicidal in nature and family disputes being the major reason for the intake of a poisonous substance. This demands that more attention be given to psychological and family counseling to resolve any disputes, as well as psychological management of poisoning cases after medical management. Also, a strong regulatory mechanism should be imposed to control the easy access to poisonous substances.
ABSTRACT
After almost a year of declaring COVID-19 a global pandemic, unusual presentations of the disease continue to be reported. Very little is known about its association with pleural disease. Here, we present a case of empyema thoracis in a 39-year-old male admitted with COVID-19. The pleural fluid later turned serosanguinous and eventually bleeding from other sites also occurred. During his treatment, antibiotics were given, thoracocentesis was performed and later thoracotomy was done. He died on the 19th day of admission following a hemorrhagic stroke. Pleural disease, although considered atypical and unusual presentation of COVID-19, needs careful and prompt diagnosis and earliest intervention. COVID-19, being a disease that involves multiple systems, and presentation of the disease may eventually lead to circulatory dysfunction and hence should be kept under consideration.