Letters to the Editor 2. 3. 4. 5. 6.

Mainini  SE, Johnson  FE. Tension pneumothorax complicating small‑caliber chest tube insertion. Chest 1990;97:759‑60. Porcel  JM, Brieva  L, Antoni Schoenenberger  J. Acute transient ataxia caused by local lidocaine injection during insertion of a pleural catheter. Arch Bronconeumol 2009;45:472‑3. Hwang MS, Chu JJ, Su WJ. Diaphragmatic paralysis caused by malposition of chest tube placement after pediatric cardiac surgery. Int J Cardiol 2005;99:129‑31. Nahum  E, Ben‑Ari  J, Schonfeld  T, Horev  G. Acute diaphragmatic paralysis caused by chest‑tube trauma to phrenic nerve. Pediatr Radiol 2001;31:444‑6. Hassan WU, Keaney NP. Winging of the scapula: An unusual complication of chest tube placement. J Accid Emerg Med 1995;12:156‑7.

7.

Rosing JH, Lance S, Wong MS. Ulnar neuropathy after tube thoracostomy for pneumothorax. J Emerg Med 2012;43:e223‑5. Access this article online

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DOI: 10.4103/2229-5151.152350

Predictors of mortality in poisonous snake bite Dear Editor, Sir, we would like to discuss on the report on “Predictors of mortality in poisonous snake bite.[1]” Chaudhari et al., reported that “mortality in patients with snake bite can be predicted by simple variables like presence of bleeding tendencies, respiratory failure, and shock.[1]” In fact, there is a similar report on this topic from India by David et al.[2] In the study by David et al., another interesting factor that is not mentioned by Chaudhari et al., is the “pre‑hospital delay.[2]” In fact, as an acute disease, the early diagnosis and prompt treatment is the key principle for management of poisonous snake bite. Finally, it should be noted that the skill of medical care provider in management of poisonous snake bite is another possible factor to be addressed. According to a report from Thailand, a country with high incidence of poisonous snake bite, “ training programs on appropriate management of snakebites for the medical and paramedical[3]” was necessary to reduce the mortality.

Address for correspondence: Prof. Sim Sai Tin, Medical Center, Shantou, China. E‑mail: [email protected]

REFERENCES 1. 2. 3.

Chaudhari TS, Patil TB, Paithankar MM, Gulhane RV, Patil MB. Predictors of mortality in patients of poisonous snake bite: Experience from a tertiary care hospital in central India. Int J Crit Illn Inj Sci 2014;4:101‑7. David S, Matathia S, Christopher S. Mortality predictors of snake bite envenomation in southern India-a ten‑year retrospective audit of 533 patients. J Med Toxicol 2012;8:118‑23. Buranasin  P. Snakebites at Maharat Nakhon Ratchasima Regional Hospital. S Asian J Trop Med Public Health 1993;24:186‑92. Access this article online

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DOI: 10.4103/2229-5151.152351

Sim Sai Tin, Viroj Wiwanitkit1

Medical Center Unit, Shantou, 1Department of Tropical Medicine, Hainan Medical University, Hainan, China

Guillain–Barré syndrome presenting as Bell’s palsy with crossed hemiparesis Dear Editor, The rare variants of Guillain–Barré syndrome (GBS) are Miller–Fisher and Bickerstaff’s brainstem encephalitis, and facial diplegia. [1] GBS can very rarely present as crossed hemiparesis, which occurred in our case. A 45‑year‑old female presented with left‑sided Bell’s palsy [Figure 1a] for 1 day with right‑sided hemiparesis. The reflexes were diminished bilaterally and plantars were mute. First possibility in this case was a posterior circulation stroke, but her MRI brain ruled out any infarct or hemorrhage. On 2 nd  day, she developed quadriparesis with facial 62

diplegia [Figure 1b], dysphagia, and bulbar palsy. Now we could make a confident diagnosis of GBS and cerebrospinal fluid (CSF) examination also showed albumino‑cytological dissociation (proteins 259 mg/ dl and total leukocyte count of 4 cells/mm 3). She was treated with intravenous immunoglobulins and a month later she came back walking without support and facial diplegia was also improving [Figure 1c and d]. To conclude, GBS can very rarely present as Bell’s palsy with crossed hemiparesis. Vivek Chauhan, G Sharma, B S Rana, V Jearth, J Sandhu

International Journal of Critical Illness and Injury Science | Vol. 5 | Issue 1 | Jan-Mar 2015

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