ABSTRACT
Incidences of multiple bee stings have been increasing globally; the substantial amount of bee venom injected in such incidents can result in anaphylactic shock, rhabdomyolysis and renal failure, proving fatal in some cases. While anaphylactic reactions are more common and have established treatment protocols, inflammatory response induced by the venom demands a tailored approach. Here we report a case of a 70-year-old male in India who succumbed from approximately 500 bee stings. Based on our literature review, this case stands out as one of the first reported fatalities caused by 500 bee stings in our country. The unidentified species of bees in this case makes management of such bee venom-related toxic reactions more difficult. This report emphasises the importance of prompt and appropriate interventions.
ABSTRACT
The concept of brain death has been a very intriguing topic and has taken many forms over the years. Brain stem death is a complex state of inactivity defined by the loss of reflexes of the pathways that pass through the brain stem, the 'shaft' of the brain which links the spinal cord to the cerebral cortex and the cerebellum where there is apnoea, loss of eye movement and pain sensation. There are many criteria, based on which a person can be said to be brain dead. The best recognised of these are the Harvard, Minnesota and Philadelphia criteria. India follows the UK notion of brain stem death, and the Transplantation of Human Organs Act was passed in 1994 by the Indian parliament, which legalised brain-stem death, and in 1995 ordered the brain death certification procedure, which is certified by a 'Board of Medical Experts'. Also, there are some legal and ethical implications that have to be considered in cases of disagreement in diagnosis among the panel of doctors, time of death in cases when patients' relatives disagree or request more time for organ donation or to disconnect the life support system. In routine clinical practice, the issues pertaining to brain stem death should be dealt with by experienced physicians, counselling the family members or relatives and educating them about organ donation.