[Trauma and multiple sclerosis; deterioriation with fatal outcome after trepanation].
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A study of 38 patients with infectious-allergic myocarditis included clinical laboratory investigation, echocardiography, catheterization of the right heart compartments and the pulmonary artery and endomyocardial biopsy. It has identified adverse factors contributing to fatal outcome: increased end-diastolic pressure in the pulmonary artery, low cardiac output, signs of macrofocal fibrosis and small ejection fraction.
Current available data on snake bites in Nepal are based solely on hospital statistics. This community-based study aimed at evaluating the impact of snake bites and determining the risk factors associated with a fatal outcome in southeastern Nepal. A total of 1,817 households, selected by a random proportionate sampling method, were visited by trained field workers in five villages. Extensive data from snake bite victims during the 14 previous months were recorded and analyzed. One hundred forty-three snake bites including 75 bites with signs of envenoming were reported (annual incidence = 1,162/100,000 and 604/100,000, respectively), resulting in 20 deaths (annual mortality rate = 162/100,000). Characteristics of krait bites such as bites occurring inside the house, while resting, and between midnight and 6:00 am were all factors associated with an increased risk of death, as were an initial consultation with a traditional healer, a long delay before transport, and a lack of available transport. An initial transfer to a specialized treatment center and transport by motorcycle were strong protective factors. Among the 123 survivors, wounds required dressing and surgery in 30 (24%) and 10 (8%) victims, respectively, the mean working incapacity period was 15 days, and the mean out-of-pocket expense was 69 U.S. dollars. Snake bite is a major but neglected public health problem in southeastern Nepal. Public health interventions should focus on improving victims' rapid access to anti-snake venom serum by promoting immediate and fast transport to adequate treatment centers, particularly for bites occurring at night.
The case of an 18-year-old mentally retarded boy who had long standing idiopathic megacolon and pica is presented. Acute toxic dilatation of the colon complicating pseudomembranous colitis developed, with a rapidly fatal outcome. No similar case of relatively benign idiopathic megacolon complicated by pseudomembranous colitis and toxic megacolon has been reported. The pathophysiology of this rare combination is discussed.
Ethylene-di-bromide is a popular fumigant. Delayed long-term effects of this chemical include carcinogenicity and genotoxicity in animals. Only a few cases of acute ethylene-di-bromide toxicity have been reported and all of them have resulted in a fatal outcome. We report the first case of ethylene-di-bromide poisoning presenting with acute renal failure and toxic hepatitis that was managed successfully.
The influence of medical factors, such as active detection of the disease and therapeutic efficiency within the first-year follow-up, on the outcome of tuberculosis was studied. It was ascertained that about half the patients with active tuberculosis could not be undetected if goal-oriented measures to attract persons to screening were not made. Fatal outcomes were more common in patients with untimely diagnosed disseminated tuberculosis with bacterial isolation and decay. The patient's awareness of the disease and readiness to contact medical staff are of great importance for good results of therapy and recovery.