Management of respiratory failure in severe neuroparalytic snake envenomation.

Fourteen patients with severe neuroparalytic snake envenomation, resulting in acute type II respiratory failure, admitted to respiratory critical care unit for mechanical ventilation during one year period, were studied. Ventilatory requirements, amount of anti snake venom (ASV) infused, period of neurological recovery and hospital survival were evaluated. All patients had severe manifestations such as ptosis, extraocular muscle paresis and limb weakness along with dyspnoea. Seven patients (50%) had additional complaints of dysphagia and dysphonia. ASV was administered to all, with a median requirement of 900 ml. Mechanical ventilation was required for a median duration of 17 hours and all except one patient, who had suffered irreversible hypoxic cerebral injury prior to resuscitation, survived with complete neurological recovery. We conclude, that the timely institution of ventilatory support and anti-venom therapy in such patients, is associated with an excellent outcome.

Incidence of tuberculosis among patients receiving treatment with oral corticosteroids.

OBJECTIVES: To study the incidence and pattern of tuberculosis in patients taking systemic corticosteroids (CS). METHODS: Seventy seven patients taking oral CS for various respiratory diseases and eighty patients suffering from similar diseases but not receiving steroids were followed up for one year to study the incidence of tuberculosis. RESULTS: Five patients (6.5%) receiving CS developed tuberculosis as against none amongst the controls (p < 0.05). Of these, three patients had sputum positive pulmonary tuberculosis and one each had sputum negative pulmonary tuberculosis and tubercular meningitis. All patients were treated with standard anti-tubercular therapy; four patients improved whereas one died due to complications of disease. CONCLUSION: Systemic CS therapy causes a significant increase in incidence of tuberculosis.

Pulmonary function changes after large volume paracentesis.

OBJECTIVE: To study the effect of large volume paracentesis (LVP) on pulmonary function in patients with cirrhosis of liver and tense ascites. METHODS: Ten patients having alcoholic cirrhosis with ascites were subjected to LVP (mean 6.3 +/- 0.3 L). Pre and post paracentesis spirometry and arterial blood gas analysis were performed and compared. RESULTS: Baseline mean lung volumes and arterial pO2 were reduced from normal predicted values. Air flow was found normal. After LVP, an increase in absolute values of vital capacity, forced expiratory flow in first second (FEV1) and peak expiratory flow was observed; only the improvement in FEV1 was significant p 0.05). Arterial pO2 also showed significant (p < 0.01) improvement after LVP. CONCLUSION: LVP leads to improvement in measured pulmonary function.

Acute respiratory distress syndrome complicating typhoid fever.

We report a case of a young female patient with typhoid fever whose clinical course was complicated by hypotension, thrombocytopenia, encephalopathy and acute respiratory distress syndrome (ARDS). She recovered with prompt mechanical ventilatory support. ARDS in typhoid fever has generally proved to be fatal in reported cases.