Accidental asphyxiation by an Arabic headscarf

Self-strangulation is an important cause of homicidal and suicidal injury, leading to death due to asphyxia and may be accidental or suicidal. Accidental strangulation is rare, and to be strangulated by a scarf is even less common. We report a 19-year-old male who was accidentally strangulated by his own scarf or 'ghutra' [a traditional cotton headdress worn by Arab males], while working on his idle vehicle engine, resulting in anoxic brain encephalopathy. The patient remained in a persistent vegetative state and ventilator dependent

Dynamics of brain natriuretic peptide in critically ill patients with severe sepsis and septic shock

Changes of B-type natriuretic peptide [BNP] in sepsis and its utility in predicting intensive care unit outcomes remains a conflicting issue. To investigate the changes in plasma levels of BNP in patients with severe sepsis/septic shock and to study the association of BNP levels with the severity of the disease and prognosis of those patients. Thirty patients with severe sepsis or septic shock were enrolled in our study. BNP measurements and echocardiography were carried out on admission and on 4[th] and 7[th] days. Blood concentrations of BNP were measured by commercially available assays [Abbott methods]. In-hospital mortality and length of stay were recorded multivariate analyses adjusted for acute physiology and chronic health evaluation score II [APACHE II score] was used for mortality prediction. Twenty patients admitted with the diagnosis of severe sepsis and 10 patients with septic shock. The in-hospital mortality was 23.3% [7 patients]. Admission BNP was significantly higher in the non-survivors 1123 +/- 236.08 versus 592.7 +/- 347.1 [P<0.001]. By doing multivariate logestic regression, the predicatable variables for mortality was APACHE II score, BNP, and then EF. BNP concentrations were increased in patients with severe sepsis or septic shock and poor outcome was associated with high BNP levels; thus, it may serve as a useful laboratory marker to predict survival in these patients

Reported survival with severe mixed acidosis and hyperlactemia after toluene poisoning

Lactic acidosis is a recognized complication of the inhalant abuse such as toluene, especially in patients with renal insufficiency. We report a case of severe metabolic acidosis and hyperlactemia due to toluene sniffing. The favorable outcome, despite extremely poor clinical symptoms, signs, laboratory and radiological findings, was unexpected. Specific aspects of the clinical course are addressed. Toluene sniffing should be considered in evaluating sever metabolic acidosis. Favorable outcome could be achieved with early diagnosis and proper interventions