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Indian Journal of Critical Care Medicine

Deepanshu Dhiman, Vikas Saini, Sameer Sethi, Tanvir Samra
No abstract text is available yet for this article.
October 2018: Indian Journal of Critical Care Medicine
Vikas Sikri, Vinay Singhal, Sandeep Chopra
Non Invasive Ventilation (NIV) is frequently used in Obstructive Airway Disease (OAD) especially COPD (Chronic Obstructive Pulmonary Disease). Patients often get hypoxic or retain carbon dioxide during attempts to feed the patient orally or trial of intermittent support. However, patient developing sudden bradycardia by mere taking off the mask and reverting to sinus rhythm as soon as mask is put back is extremely rare. We present one such case that was also a treatment challenge for us. Recurrent bradycardia in COPD, with repeatability on discontinuation of Non Invasive Ventilation (NIV) is an extremely rare condition with not much reports/studies in the medical literature...
October 2018: Indian Journal of Critical Care Medicine
Sarvinder Singh, Santosh Kumar Singh, Ajai Kumar Tentu, Anshu Kumar, Bhaskar Shahbabu, Vani Singh, Nidhi Singh
Autoimmune hemolytic anemia (AIHA) is a very rare cause of anemia in a case of malaria and drug-induced AIHA is even rarer. A 50-year old patient with a history of fever for 8 days was diagnosed with a case of complicated malaria with mixed infection having initial parasite index of 45%. He showed good response on initial therapy with artesunate (parasite count reduced to <1%) but his haemoglobin (Hb) continued to drop from 12 g% to 4.9 g% over a course of 11 days. Direct coombs test was positive with reduced haptoglobin and increased lactate dehydrogenase suggesting AIHA...
October 2018: Indian Journal of Critical Care Medicine
Rohit Vohra, Anil Sachdev, Dhiren Gupta, Neeraj Gupta, Suresh Gupta
Status Asthmaticus is a common reason for Emergency Room visits in children. Most of the asthma flares are successfully managed by use of β agonist and steroids. If these therapies fail to halt the progression of asthma, a number of medical therapies may be used to treat it. However, the data supporting the use of these therapies are conflicting. We present successful use of Extracorporeal Membrane Oxygenation and isoflurane in a child with Refractory Status Asthmaticus.
October 2018: Indian Journal of Critical Care Medicine
Sulakshana Sulakshana, Shashi Prakash
Hyponatremia causing seizure is a common cause for admission in the critical care unit. Here, we describe a peculiar case of seizure due to hyponatremia, associated with anti-voltage-gated potassium channel antibody syndrome. This case emphasizes that how a proper workup can unveil unusual but potentially treatable causes of hyponatremia. The hallmark of this syndrome is that neurological symptoms may relapse or progress if the disorder is not recognized in time. This case report emphasizes the point that how a keen observation may decode subtle signs of the grave but potentially treatable pathologies...
October 2018: Indian Journal of Critical Care Medicine
Supriya D'souza, Shalini Saksena, Manju Butani
Imbalances in the autonomic nervous system contribute to ventricular tachyarrhythmias. Sympatholysis with thoracic epidural analgesia or a stellate ganglion block attenuates myocardial excitability and the proarrhythmic effects of sympathetic hyperactivity.
October 2018: Indian Journal of Critical Care Medicine
Pritam Kataria, Pradip Kendre, Apurva Patel, Nahush Tahiliani, Sushant Ikhar
Acute lymphoblastic leukemia (ALL) is the most common malignancy in pediatric patients, and it is characterized by the presence of malignant lymphoblasts within the bone marrow and peripheral blood. The treatment of ALL involves induction, consolidation, reinduction, and maintenance therapy. Consolidation therapy in ALL-Berlin-Frankfurt-Münster 90 protocol involves the use of high-dose methotrexate (HDMTX, 5 g/m2 ) over 24 h as continuous infusion. The adverse effects due to HDMTX include renal dysfunction in 2%-12% patients, which can lead to increased systemic MTX exposure, leading to further myelosuppression, mucositis, hepatotoxicity, skin toxicity, and, in severe cases, multiorgan failure...
October 2018: Indian Journal of Critical Care Medicine
Robert Da Costa, Pezad Doctor, Kaustubh Mahajan, Vidyadhara G Lakkappan
Neuropathy is one of the major reasons of morbidity in diabetes mellitus (DM). We presented a 64-year-old male who was a case of type 2 DM for >6 years. He presented with orthopnea and respiratory failure secondary to bilateral phrenic neuropathy and resultant diaphragmatic palsy. Clinical examination, ultrasound, and nerve conduction studies confirmed the bilateral involvement of the phrenic nerves. Phrenic neuropathy may be an important, albeit a rare complication of diabetes, and hence, diaphragmatic dysfunction associated with diabetic phrenic neuropathy should be considered in any patient with unexplained breathlessness, orthopnea, and respiratory failure...
October 2018: Indian Journal of Critical Care Medicine
Jayagowri Karthikeyan, Sujatha Rajaragupathy
Context: Diabetes mellitus is one of the most prevalent diseases worldwide. One of the acute complications of diabetes mellitus is diabetic ketoacidosis. It becomes essential for the healthcare physicians to identify the individuals who are likely to be prone to the development of ketosis. Serum albumin levels may be a cost-effective and simple parameter to prognosticate the risk of ketosis. Aims: This study was done to find a relationship between serum albumin levels and ketonuria...
October 2018: Indian Journal of Critical Care Medicine
Helmut Schiffl
Critically ill patients with severe acute kidney injury (AKI-D) require renal replacement therapy (RRT) increasingly. However, the optimal timing of initiation of RRT for non-life-threatening indications of AKI remains unknown. There is a debate as to whether different philosophies of RRT initiation (early vs. delayed) confer a survival benefit. Lowering the threshold for RRT initiation, however, inevitably leads to more critically ill patients receiving unnecessary RRT. The relevant proportion of nonprogressing early stage AKI patients with spontaneous kidney recovery is a matter of severe concern because RRT has potentially lethal complications and is expensive...
October 2018: Indian Journal of Critical Care Medicine
Nitin Bhagwan Mali, Siddharth P Deshpande, Niteen D Karnik, Nithya J Gogtay, Renuka P Munshi, Jigeeshu V Divatia, Sanjay C Wagle, Kannan Sridharan, Urmila Mukund Thatte
Rationale: Antibacterials are largely prescribed to the intensive care unit (ICU) patients due to high prevalence of infections. However, appropriate use of antibacterials is imperative; since the misuse of antibacterials increases antibacterial resistance and ultimately, it has negative impact on health care and economic system. Hence, continuous antibacterials prescription assessments are very important to judge and improve prescription patterns. The present work was carried out at public and private hospitals to assess the differences in antibacterial prescribing pattern...
October 2018: Indian Journal of Critical Care Medicine
Hiren Anghan, Prayas Sethi, Manish Soneja, Sandeep Mahajan, Naveet Wig
Introduction: Critically ill severe malaria constitutes one of the major hospital admissions in Indian setting. Clinical studies identifying the factors associated with acute kidney injury (AKI) in malaria are lacking. This study aimed to identify these factors. Methods: This prospective observational study was conducted in a tertiary care center of North India. All adult patients with severe malaria were studied during 2012-2014. Results: The study included 79 patients and AKI was observed in 36 patients...
October 2018: Indian Journal of Critical Care Medicine
Girish Chandrakant Rajadhyaksha, Ameena Meah
Background and Aims: In a medical intensive care unit (MICU), many patients develop hemostatic abnormalities, ranging from abnormal clotting tests to frank bleeding. The aim of this study was to assess the etiology of diseases that present with bleeding, its common bleeding manifestations, incidence, MICU stay, mortality, and transfusion requirements in an Indian setup and also to assess if the Acute Physiology and Chronic Health Evaluation II (APACHE II) score can be used as a predictor for blood transfusion requirements...
October 2018: Indian Journal of Critical Care Medicine
Prasanth Balasubramanian, Navneet Sharma, Manisha Biswal, Ashish Bhalla, Susheel Kumar, Vivek Kumar
Background and Aim: Scrub typhus (ST) is an acute infectious disease of variable severity caused by Orientia (formerly Rickettsia ) tsutsugamushi . The disease can be complicated by organ dysfunctions and the case fatality rate (CFR) is approximately 15%, which further rises with the development of severe complications. We studied the clinical features of the ST and the performance of critical illness scoring systems (CISSs) - Acute Physiology and Chronic Health Evaluation (APACHE) II, sequential organ failure assessment (SOFA), and quick SOFA (qSOFA) in predicting the clinical outcomes in complicated ST (cST) patients admitted to the emergency department...
October 2018: Indian Journal of Critical Care Medicine
Sujay Samanta, Ratender Kumar Singh, Arvind K Baronia, Prabhaker Mishra, Banani Poddar, Afzal Azim, Mohan Gurjar
Aim of the Study: Metabolic acidosis is associated with increased mortality in critically ill patients. We hypothesized that early correction of acidosis of presumed metabolic origin results in improved outcomes. Patients and Methods: We conducted a prospective, observational study from February 2015 to June 2016 in a 12 bed mixed intensive care unit (ICU) of a 1000 bed tertiary care hospital in the north of India. ICU patients aged above 18 years with an admission pH ≥7...
October 2018: Indian Journal of Critical Care Medicine
Lalit Kumar Rajbanshi, Batsalya Arjyal, Rakesh Mandal
Background: Acute poisoning is a common health-care problem requiring admission in the intensive care unit (ICU) in the developing countries. The study was conducted to assess the epidemiological parameters of acute poisoning and factors affecting clinical course and outcome of the patients in ICU in the eastern part of Nepal. Methodology: This was a prospective observational study conducted at ICU of tertiary care hospital in the eastern part of Nepal for the duration of 2 years...
October 2018: Indian Journal of Critical Care Medicine
Shivakumar Mutnal, Pradeep Rangappa, Ipe Jacob, Karthik Rao
No abstract text is available yet for this article.
September 2018: Indian Journal of Critical Care Medicine
Maddalena De Bernardo, Ilaria De Pascale
No abstract text is available yet for this article.
September 2018: Indian Journal of Critical Care Medicine
Pralay Shankar Ghosh, Sukanya Naskar, Afzal Azim
No abstract text is available yet for this article.
September 2018: Indian Journal of Critical Care Medicine
S Lakshmikanthcharan, Mohamed Hisham, S K Chaitanya Juluri, Sivakumar Mundilipayalam Nandakumar
Almost one-third of the people suffering from epilepsy continue to have seizures in spite of using appropriate antiepileptics. Pharmacoresistance is defined as the failure to achieve seizure control with two or more anticonvulsant medications at appropriate daily dosage. Here, we discuss one such gentleman whose seizures had been intractable despite multiple antiepileptic drugs in maximum tolerable doses. Verapamil, a calcium channel blocker, was used for its P-glycoprotein inhibition properties to overcome the pharmacoresistance in this patient with satisfactory seizure control...
September 2018: Indian Journal of Critical Care Medicine
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