Efficacy of Nyagrodh Twak Lepa in Honey bee sting: In-vivo study

Introduction- As Acharya Charaka has explained the local application of Kshirivruksha Twak to cure all types of keeta visha, hence Nyagrodh (Ficus benghalensis L.) Twak Lepa with water as base is selected as Trial drug on Apis Cerana Indica bee sting poisoning. Material and Methods- An in-vivo study on albino mice to know the efficacy of trial drug has been planned after animal ethical clearance. 18 albino mice were prorated into three groups with 6 animals in each group viz. Control group, Trial drug (Nyagrodh Twak Lepa Churna) group and Standard drug (Beclomethasone Dipropionate 0.025% w/w) group. 6 stings were given to each mice and 3 stings were removed after sting operation. All mice were observed for allergic reactions viz. erythema, scaling, fissures, oedema and mortality for a period of 7 days. Histo-pathological changes were also noted after completion of study. Statistical analysis was done using Paired t test. Results- Results revealed that Trial drug had worked more efficiently on Erythema and Oedema while Standard drug worked more efficiently on Scaling and Fissure. Histo-pathology showed that wound healed with Nyagrodh twak lepa and Standard drug have shown almost similar changes while wound in control group showed extensive areas of necrosis. Conclusion- Present study suggests that both Nyagrodh and Beclomethasone can be used in Honey bee sting poisoning but as Nyagrodh being a religious tree can be easily identified by a common man, it can be employed as preliminary treatment for the same before reaching hospital.

Honey Bee Venom Re-Challenge During Specific Immunotherapy: Prolonged Cardio-Pulmonary Resuscitation Allowed Survival in a Case of Near Fatal Anaphylaxis

BACKGROUND Specific immunotherapy for patients with honey bee hypersensitivity is commonly applied. Re-challenge with venom is performed to prove protection.CASE PRESENATION We report a case of near fatal anaphylaxis with asystolia for 24 minutes in a 35-years-old patient with mastocytosis after honey bee sting challenge despite 5-years of specific immunotherapy. Successful cardio-pulmonary resuscitation (CPR) was applied for 32 minutes.CONCLUSION This intervention demonstrates, that in anaphylaxis with cardio-vascular arrest prolonged CPR for up to 40 minutes might be appropriate to overcome half time span of massively released histamine. Failure of specific immunotherapy was possibly due to sensitization to the allergen Api m10, probably underrepresented in commercial honey bee venom extracts. Also, molecular analyses might alert to potential unsuccessful outcome of venom specific immunotherapy especially in high-risk patients such as mastocytosis.

Evaluation of Knowledge About Anaphylaxis in Dentistry and Medical Faculty Students; Need for More Training

Objective: Anaphylaxis is a serious reaction that needs rapid intervention. However, some healthcare professionals may have inadequate knowledge about anaphylaxis to manage this situation. The aim of this study was to evaluate the level of knowledge about anaphylaxis in dentistry students (DS) in comparison with medical school ones (MS). Materials and Methods: Students were recruited from the Dentistry (n=81) and Medical (n=144) Faculties of the University Hospital. The level of knowledge about anaphylaxis was evaluated by using a questionnaire with 26 items that was used previously. Results: The overall response rate was 89.9%. One tenth of the study group had ever encountered a case with anaphylaxis, but 2.8% of them stated that they had involved in the treatment by themselves. Almost all of the participants stated that allergy might be a life-threatening reaction. Additionally, 43.3% reported that they had epinephrine in their department. DS knew less than MS about the primary use of epinephrine after assessing the airway, breathing and circulation in the treatment of anaphylaxis, and even in suspicious cases (59.3% vs. 98.6%, and 42% vs. 94.4%, all p<0.001). DS had significantly less knowledge about anaphylaxis treatment and epinephrine application than medical ones (all p <0.001). Furthermore, the information of that “the minimum duration for re-administration of epinephrine as 10 minutes” was known by the half of MS, and one fourth of DS (p<0.001). The appropriate follow-up duration of patients with anaphylaxis was unknown in half of DS, and one fifth of MS (p<0.001). Even though MS had a higher rate of knowledge about the responsible and closest department dealing with anaphylaxis than dental students (p=0.02), DS were more aware of referring the patient with anaphylaxis to an allergy clinic (77.8% vs. 62.9%, p<0.001). Almost all MS had heard about the epinephrine auto-injector, in contrast to one third of the DS (p<0.001). Most of the participants, but mainly the MS knew that anaphylaxis could be diagnosed clinically. The case questions about diagnosis of anaphylaxis related to local anesthetic and beta-lactam antibiotic use were answered correctly in a higher rate in MS than DS (p=0.01 and p<0.001), whereas the rate of correct diagnosis of anaphylaxis following a bee sting was similar between the groups. Conclusion: This study showed the gaps about the diagnosis and management of anaphylaxis not only in MS, but also in dentistry ones. It is possible to encounter a case of anaphylaxis for every student during clinical practice in the future. Thus, education about anaphylaxis should be included in the national dentistry core education programme and be improved in the medical school as well. Keywords: Anaphylaxis, epinephrine, student, medical, denta

Visual Loss Caused by Central Retinal Artery Occlusion After Bee Sting: A Case Report

A bee sting can lead to an extremely rare case of visual loss caused by central retinal artery occlusion (CRAO). In this study, we report a 66-year-old healthy woman who was referred to our Eye Center because of visual loss, which had occurred after bee sting 2 days earlier. The visual acuity was no light perception (NLP). Examination revealed left eyelid edema, conjunctiva congestion, a 6-mm fixed pupil, scattered retinal hemorrhage, and white-appearing ischemic retina with one small area of the normal-appearing retina temporal to the optic disk. Fundus fluorescein angiography revealed CRAO with one cilioretinal artery sparing. Her systemic workup revealed hypersensitivity, hypercoagulable state, myocardial damage, and hepatic damage. After topical and systemic treatments, the visual acuity was still NLP with improved systemic workup. In brief, CRAO may occur after bee sting, and visual acuity should be monitored for early diagnosis.

Bee sting leading to stroke: a case report and review of the literature

In India, bee stings are very common, seen mainly in farmers and honey collectors. Usually, it presents with local reactions and anaphylaxis. It rarely requires urgent hospitalisation. Other major complications seen are acute renal failure, intravascular coagulation, rhabdomyolysis and acute pulmonary oedema. Stroke as a presentation is uncommon. We report a case of a 45-year-old man presenting with right-sided hemiplegia and aphasia due to multiple bee stings. Diffusion MRI showed left middle cerebral artery territory hyperacute infarct.

Kounis Syndrome in a Clinical Case

Kounis syndrome is the grouping of an acute coronary artery disease associated with an anaphylactic allergy, in which there is an antigen-antibody reaction caused by the release of inflammatory mediators and mast cells act by causing degranulation, and in this situation there is the presence of cells of inflammation, causing an anaphylactic reaction. There are several triggers that can trigger an allergic reaction and therefore Kounis syndrome, patients with atopy are more susceptible, it has been associated with insect bites, medications and some foods, environmental contamination and some medical conditions. Any age because it has been described even in children. There are not many clinical studies, nor a larger sample of patients to reach a consensus on this pathology. We present a 46-year-old patient who is admitted to the Emergency service of the national institute of cardiology and cardiovascular surgery in Havana. Cuba; with a history of Systemic Arterial Hypertension (HT), which is an increase in blood pressure above the upper limits of normality. Grade II obesity, which is a body mass index ≥35. In addition to referred dyslipidemia. In the results according to the diagnostic criteria of Kounis syndrome, the following were found: Signs and symptoms of myocardial ischemia, urticaria, pruritus, dyspnea, sinus tachycardia after bee sting. Electrocardiogram (ECG): With ST segment elevation in 2 or more continuous leads. Echocardiography: Transient segmental motility disorders. Cardiac chambers of preserved size and function. Serum myocardial biomarkers within normal parameters, increased Histamine, Tryptase, leukotriene values. The objective is to describe the clinical characteristics, complementary examinations, their diagnosis, evolution and treatment. It was concluded that the diagnosis of Kounis syndrome is eminently clinical. in itself everything that leads to the activation of mast cells can produce the syndrome. The prognosis depends on the type of Kounis, cardiovascular risk factors and pre‐existing coronary artery disease. Keywords: ischemia, inflammatory response, angina, vasospasm, atherosclerosis, histamine. RESUMEN El síndrome de Kounis es la agrupación de una arteriopatía coronaria aguda asociado a una alergia anafiláctica, en la que hay una reacción antígeno-anticuerpo causado por la liberación de mediadores inflamatorios los mastocitos y estos actúan provocando degranulación, y ante esta situación hay presencia de células de la inflamación, provocando una reacción anafiláctica. Existen varios gatillantes que pueden desencadenar una reacción alérgica y por ende el síndrome de Kounis, son más susceptibles los pacientes con atopia, se le ha relacionado mucho con picaduras de insectos, medicamentos y algunos alimentos, contaminación ambiental y algunas condiciones médicas Se puede presentar a cualquier edad porque se ha descrito incluso en niños. No hay muchos estudios clínicos, ni una muestra más grande de pacientes para realizar un consenso de esta patología. Presentamos una paciente de 46 años de edad que es ingresada al servicio de Emergencia del instituto nacional de cardiología y cirugía cardiovascular de la habana. Cuba; con antecedente de Hipertensión Arterial Sistémica (HTA) que es aumento de la presión arterial por encima de los limites superiores de normalidad. Obesidad grado II que es el índice de masa corporal ≥ 35. además de dislipidemia referida. En los resultados según los criterios diagnóstico del síndrome de Kounis se encontró: Signos y síntomas de isquémica miocárdica, urticaria, prurito, disnea, taquicardia sinusal tras picadura de una abeja. Electrocardiograma (ECG): Con elevación del segmento ST en 2 o más derivaciones continuas. Ecocardiografía: Trastornos de motilidad segmentaria transitorio. cavidades cardiacas de tamaño y función conservada. Los biomarcadores miocárdicos sérico dentro de los parámetros normales, incremento de los valores de Histamina, Triptasa, leucotrienos. El objetivo es describir las características clínicas, exámenes complementarios, su diagnóstico, evolución y tratamiento. Se concluyó que el diagnóstico del síndrome de Kounis es eminentemente clínico. en sí todo lo que conlleve a la activación de mastocitos puede producir el síndrome. El pronóstico depende del tipo de Kounis, de los factores de riesgos cardiovasculares y coronariopatía preexistente. Palabras claves: isquemia, respuesta inflamatoria, angina, vasoespasmo, ateroesclerosis, histamina.

Bee sting presumed endophthalmitis: a devastating ocular outcome

Background To report a rare case of bee sting presumed endophthalmitis that resulted in a devastating ocular outcome. Case presentation A 43-year-old patient presented 24 h after bee sting ocular injury in his left eye. He had a mild inflammatory sign at presentation, and he underwent surgical exploration to rule out a scleral defect, which revealed a sealed defect. During his hospital course, he developed signs of endophthalmitis 48 h following trauma for which he received vitreous tap and intravitreal antibiotic. Microbial culture revealed gram-negative rods, Pseudomonas aeruginosa, and Aeromonas veronii. Condition escalated to reach the panophthalmitis stage and cellulitis like picture with visual acuity of no light perception. Visual evoked response (VER) demonstrated a flat response. Infection was controlled by evisceration of the globe at the end as salvage therapy against the spreading of infection Conclusions Bee sting ocular injury is an exceedingly rare type of ocular trauma. Concomitant infection can happen, and severity depends on the pathogen involved. It is crucial to have insight and start appropriate treatment based on to the patient presentation.