A Rare case of Listeria monocytogenes meningitis in an immunocompetent adult
Thejeswini Mahadevaiah, Pradeep Rangappa, Ipe Jacob, Karthik RaoIndian Journal of Critical Care Medicine 2018 22(12):892-893 (Source: Indian Journal of Critical Care Medicine)
Source: Indian Journal of Critical Care Medicine - December 18, 2018 Category: Intensive Care Authors: Thejeswini Mahadevaiah Pradeep Rangappa Ipe Jacob Karthik Rao Source Type: research

Junctional rhythm: A rare sign in leptospirosis
Rachana Warrier, Santosh Kumar Singh, Sarvinder Singh, Ajai Kumar Tentu, Nidhi Singh, Chinmaya Dash, Vani SinghIndian Journal of Critical Care Medicine 2018 22(12):889-891Leptospirosis is an important re-emerging infectious disease. Leptospirosis has been estimated to affect tens of millions of humans annually with a case fatality rate ranging from 5% to 25%; however, it is underreported due to the lack of clinical suspicion and barriers to diagnostic capacity. A 33-year-old healthy male presented with a history of fever of 2-day duration. His examination revealed icterus. His workup did not show any significant fi...
Source: Indian Journal of Critical Care Medicine - December 18, 2018 Category: Intensive Care Authors: Rachana Warrier Santosh Kumar Singh Sarvinder Singh Ajai Kumar Tentu Nidhi Singh Chinmaya Dash Vani Singh Source Type: research

Multiple splenic abscesses in a case of enteric fever: Salvaging spleen through pigtail drainage and antibiotics is a good alternative approach
Vijoy Kumar Jha, Tushar VidhaleIndian Journal of Critical Care Medicine 2018 22(12):886-888Splenic abscess is a rare complication of enteric fever in developing countries. This is seen mostly solitary rather than being multiple and can be fatal if untreated. In general clinical practice, multiple splenic abscesses or thick pus with septations may require splenectomy. Here, we report a rare case of enteric fever with multiple splenic abscesses in a young immunocompetent male who was successfully managed with antibiotics and percutaneous pigtail drainage of pus from the larger cavity. (Source: Indian Journal of Critical Care Medicine)
Source: Indian Journal of Critical Care Medicine - December 18, 2018 Category: Intensive Care Authors: Vijoy Kumar Jha Tushar Vidhale Source Type: research

Extreme metabolic alkalosis and acute kidney injury in a 38-year-old male patient
We describe a case with life-threatening acid-base disturbances due to vomiting. A 38-year-old man presented to an emergency department with weakness and decreased urine output after having vomited up to 20 times per day over a period of 7 days. Arterial blood gas analysis revealed a metabolic alkalosis with partial respiratory compensation. Initial management consisted of oxygen therapy and intravenous fluid therapy with normal saline and potassium chloride. To prevent further gastric losses of HCl, proton-pump inhibitors and metoclopramide were administered. The vomiting was caused most likely by a temporary duodenal ste...
Source: Indian Journal of Critical Care Medicine - December 18, 2018 Category: Intensive Care Authors: Johannes Heymer Andreas Lienig Joachim L & #246;ffler Tobias Schilling Daniel R & #228;pple Source Type: research

Bilateral lower cranial nerve palsy after closed head injury: A case report and review of literature
Jose Chacko, Gagan Brar, Bhargav Mundlapudi, Pradeep KumarIndian Journal of Critical Care Medicine 2018 22(12):879-882Paralysis of the lower cranial nerves is uncommon after closed head injuries. Most cases reported are unilateral and associated with base of skull fractures, usually involving the occipital condyles. Bilateral lower cranial nerve palsy is even less common, with only a handful of cases reported in literature. A 17-year-old girl presented to us after she was involved in a side-on collision with a car while driving a scooter. She sustained traumatic brain injury requiring mechanical ventilation. Detailed neuro...
Source: Indian Journal of Critical Care Medicine - December 18, 2018 Category: Intensive Care Authors: Jose Chacko Gagan Brar Bhargav Mundlapudi Pradeep Kumar Source Type: research

Dilemmas and challenges in treating seronegative autoimmune encephalitis in Indian children
Conclusion: The possibility of autoimmune encephalitis should be considered in patients with super-refractory status epilepticus. A large proportion of children with suspected AE may be “seronegative.” A trial of immunotherapy should be given to these children when there is a strong clinical suspicion of autoimmune encephalitis even in the absence of cerebrospinal fluid autoantibodies. (Source: Indian Journal of Critical Care Medicine)
Source: Indian Journal of Critical Care Medicine - December 18, 2018 Category: Intensive Care Authors: Bandya Sahoo Mukesh Kumar Jain Reshmi Mishra Sibabratta Patnaik Source Type: research

Management of symmetrical peripheral gangrene
The objective of this review is to outline the etiology, pathology findings, and management practices of SPG. About 18%–40% mortality rate was reported, and survivors have high frequency of multiple limb amputations. SPG is the hallmark of disseminated intravascular coagulation (DIC). The main pathogenesis theory, to date, is microthrombosis associated with disturbed procoagulant–anticoagulant balance. The treatment of SPG is largely anecdotal and theoretically involves heparin-based anticoagulation and substitution of natural anticoagulants. Early recognition, prompt management of DIC, and underlying c...
Source: Indian Journal of Critical Care Medicine - December 18, 2018 Category: Intensive Care Authors: Agus Iwan Foead Amuthaganesh Mathialagan Raghu Varadarajan Michael Larvin Source Type: research

Extracorporeal treatment in the management of acute poisoning: What an intensivist should know ?
This article aims to provide a brief overview of the technical aspects and the potential indications and limitations of the different ECTRs, highlighting the important characteristics of poison amenable to ECTR and the most appropriate prescriptions used in the setting of acute poisoning. The various principles that govern poison elimination by ECTR (diffusion, convection, adsorption, and centrifugation) and how components of the ECTR can be adjusted to maximize clearance have also being discussed. (Source: Indian Journal of Critical Care Medicine)
Source: Indian Journal of Critical Care Medicine - December 18, 2018 Category: Intensive Care Authors: Vijoy Kumar Jha KV Padmaprakash Source Type: research

An intervention study for the prevention and control of health care-associated infection in the critical cares area of a tertiary care hospital in Saudi Arabia
Conclusion: This small study showed that strict implementation of care bundles with good compliance of hand hygiene, Personal protective equipment and antibiotic stewardship are helpful for prevention and control of hospital acquired infections. This study also demonstrated significant (28%) reduction of hospital acquired infections during the study period. (Source: Indian Journal of Critical Care Medicine)
Source: Indian Journal of Critical Care Medicine - December 18, 2018 Category: Intensive Care Authors: Sanjay Kumar Gupta Fahd Khaleefah Al Khaleefah Ibrahim Saifi Al Harbi Fiaz Ahmed Sinimol Jabar Marilou Andal Torre Sunitha Lorin Mathias Source Type: research

Six-hour sepsis bundle decreases mortality: Truth or illusion & #8211; A prospective observational study
Conclusion: Irrespective of sepsis bundle compliance (complete/incomplete), outcome depends on the severity of illness reflected by high lactate and predicted mortality. (Source: Indian Journal of Critical Care Medicine)
Source: Indian Journal of Critical Care Medicine - December 18, 2018 Category: Intensive Care Authors: Pooja Anthwal Nirmal Kumar Ayush Manchanda Bhawna Garg Source Type: research

The utilization of the surviving sepsis campaign care bundles in the treatment of pediatric patients with severe sepsis or septic shock in a resource-limited environment: A prospective multicenter trial
Conclusion: Our study demonstrated a significant reduction in sepsis mortality after the implementation of the SSC care bundles. Early diagnosis of the disease, optimum hemodynamic resuscitation, and timely antibiotic administration are the key elements of sepsis management. (Source: Indian Journal of Critical Care Medicine)
Source: Indian Journal of Critical Care Medicine - December 18, 2018 Category: Intensive Care Authors: Rujipat Samransamruajkit Kawiwan Limprayoon Rojanee Lertbunrian Rattapon Uppala Chutima Samathakanee Pravit Jetanachai Nopparat Thamsiri Source Type: research

Comparison of various severity assessment scoring systems in patients with sepsis in a tertiary care teaching hospital
Conclusions: In our study, APACHE II score was found to be the most sensitive and specific in predicting the severity of sepsis compared to other scores. (Source: Indian Journal of Critical Care Medicine)
Source: Indian Journal of Critical Care Medicine - December 18, 2018 Category: Intensive Care Authors: Keertana Badrinath Monica Shekhar Moturu Sreelakshmi Meenakshi Srinivasan Girish Thunga Sreedharan Nair Karthik Rao Nileshwar Athira Balakrishnan Vijayanarayana Kunhikatta Source Type: research

Comparison of hemodynamic monitoring between transesophageal Doppler and ultrasonography-guided inferior vena cava distensibility in supine versus prone position: A pilot study
Conclusion: IVC variability can be observed in acute respiratory distress syndrome patients in prone position. Inferior Vena Cava Distensibility correlates with flow time in both the positions. (Source: Indian Journal of Critical Care Medicine)
Source: Indian Journal of Critical Care Medicine - December 18, 2018 Category: Intensive Care Authors: Pralay Shankar Ghosh Afzal Azim Sai Saran Arvind Kumar Baronia Banani Poddar Ratender Kumar Singh Mohan Gurjar Prabhaker Mishra Source Type: research

Acute kidney injury in Malaysian intensive care setting: Incidences, risk factors, and outcome
Conclusions: AKI is common in our ICU, with higher morbidity and mortality. Independent risk factors of AKI include age, the severity of illness, sepsis and preexisting hypertension, and chronic cardiovascular disease. AKI independently contributes to mortality. The presence of AKI and sepsis increased the risk of mortality by three times. (Source: Indian Journal of Critical Care Medicine)
Source: Indian Journal of Critical Care Medicine - December 18, 2018 Category: Intensive Care Authors: Azrina Md Ralib Suhaila Nanyan Nur Fariza Ramly Lim Chew Har Tan Cheng Cheng Mohd Basri Mat Nor Source Type: research

Turnaround time for red blood cell transfusion in the hospitalized patient: A single-center & #8220;Blood Ordering, Requisitioning, Blood Bank, Issue (of Blood), and Transfusion Delay & #8221; study
Conclusion: Majority of the delay for blood transfusion happens due to the processes outside blood bank premises. Understanding the steps where delay happens has the potential to reduce the turnaround time for lifesaving procedures such as blood transfusion in the hospitalized patients. (Source: Indian Journal of Critical Care Medicine)
Source: Indian Journal of Critical Care Medicine - December 18, 2018 Category: Intensive Care Authors: Naveen Agnihotri Ajju Agnihotri Source Type: research

Author reply
Tuna Demirdal, Pinar Sen, Salih Atakan NemliIndian Journal of Critical Care Medicine 2018 22(11):820-820 (Source: Indian Journal of Critical Care Medicine)
Source: Indian Journal of Critical Care Medicine - November 19, 2018 Category: Intensive Care Authors: Tuna Demirdal Pinar Sen Salih Atakan Nemli Source Type: research

Severe sepsis due to chryseobacterium indologenes, a possible emergent multidrug-resistant organism in intensive care unit-acquired infections
We present two cases of C. indologenes infections which were hospital acquired. The pandrug-resistant nature of the bacteria and the associated mortality were uncommon with these two cases. (Source: Indian Journal of Critical Care Medicine)
Source: Indian Journal of Critical Care Medicine - November 19, 2018 Category: Intensive Care Authors: Sonika Agarwal Barnali Kakati Sushant Khanduri Source Type: research

Ventriculitis caused by multidrug-resistant bacteria in a medical intensive care unit with limited resources
Pedja Kovacevic, Sasa Dragic, Vlado DjajicIndian Journal of Critical Care Medicine 2018 22(11):814-816The widespread use of various devices in the diagnosis or treatment of critically ill neurological patients has led to the more frequent appearance of a new group of meningitis and ventriculitis caused by resistant Gram-negative bacteria or staphylococci. In literature, it has been labeled as health care-associated meningitis and ventriculitis. In our clinical practice (in resource-limited countries), we still have any viable experience neither in the application of these diagnostic and therapeutic tools nor in the handlin...
Source: Indian Journal of Critical Care Medicine - November 19, 2018 Category: Intensive Care Authors: Pedja Kovacevic Sasa Dragic Vlado Djajic Source Type: research

Disseminated pyomyositis due to Burkholderia cepacia: A case report
We report a case of B. cepacia pyomyositis in a patient with no history of immunocompromised status, manifesting as disseminated infection with hemophagocytic syndrome presenting to our intensive care unit. (Source: Indian Journal of Critical Care Medicine)
Source: Indian Journal of Critical Care Medicine - November 19, 2018 Category: Intensive Care Authors: Sai Saran Vijay Sundar Singh Sagarika Panda Mohan Gurjar Krushna Chandra Pani Kalyani Borde Afzal Azim Source Type: research

Bilateral parotid enlargement and trismus: An unexpected clinical finding in a patient with common krait (Bungarus caeruleus) bite
We report a case of bilateral parotid enlargement and trismus due to the bite of common krait (Bungarus caeruleus). These clinical findings have not been reported in literature after the bite with this species. (Source: Indian Journal of Critical Care Medicine)
Source: Indian Journal of Critical Care Medicine - November 19, 2018 Category: Intensive Care Authors: Sujeet Raina Bhagwan Dass Negi Sayan Malakar Rajesh Sharma Mahesh Kumar Source Type: research

Papillary muscle dysfunction due to coronary slow-flow phenomenon presenting with acute mitral regurgitation and unilateral pulmonary edema
We present a 30-year-old man who developed acute coronary syndrome following an overdose of alprazolam. He developed breathlessness with unilateral infiltrates on the chest radiograph. Echocardiography revealed regional wall motion abnormalities related to underlying ischemia and acute mitral regurgitation with an eccentric jet. Besides, he had significant impairment of left ventricular systolic function. His coronary angiogram revealed a slow-flow phenomenon in the right coronary and left anterior descending artery territories. Ischemia-related dysfunction of the posterolateral papillary muscle probably led to a floppy po...
Source: Indian Journal of Critical Care Medicine - November 19, 2018 Category: Intensive Care Authors: Jose Chacko Gagan Brar Bhargav Mundlapudi Pradeep Kumar Source Type: research

A case of keraunoparalysis: A bolt from the blue
Sadananda B Naik, RV Murali KrishnaIndian Journal of Critical Care Medicine 2018 22(11):804-805Keraunoparalysis is a catastrophic but fortunately totally reversible neuroparalysis of the limbs occurring due to a lightning strike. One such case with transient right hemiparesis along with a brief account of the pathophysiology of this unique neurologic problem has been presented here. (Source: Indian Journal of Critical Care Medicine)
Source: Indian Journal of Critical Care Medicine - November 19, 2018 Category: Intensive Care Authors: Sadananda B Naik RV Murali Krishna Source Type: research

Fatal iron toxicity in an adult: Clinical profile and review
We report an instance wherein an adult committed suicide by ingestion of multiple iron tablets. Delay in treatment was there due to misdiagnosis of the intoxicating agent. She developed fulminant hepatic failure with rapid clinical deterioration. Despite aggressive supportive management, the patient succumbed to the toxic doses of iron. Clinical course and postmortem features are discussed with a review of the literature. (Source: Indian Journal of Critical Care Medicine)
Source: Indian Journal of Critical Care Medicine - November 19, 2018 Category: Intensive Care Authors: Mandar Ramachandra Sane Kamal Malukani Rashmi Kulkarni Abhishek Varun Source Type: research

Factors affecting early treatment goals of sepsis patients presenting to the emergency department
Conclusion: The sepsis bundle goals were not achieved because of various factors such as under triaging, delay in diagnosis, logistical delay, and financial constraints. Further studies on whether sensitization of medical fraternity about sepsis, implementation of insurance policies for patient care or better point of care diagnostics would aid in achieving the bundles may be evaluated further. (Source: Indian Journal of Critical Care Medicine)
Source: Indian Journal of Critical Care Medicine - November 19, 2018 Category: Intensive Care Authors: CK Kassyap Siju V Abraham S Vimal Krishnan Babu Urumese Palatty PC Rajeev Source Type: research

Lung ultrasound and blood gas-based classification of critically ill patients with dyspnea: A pathophysiologic approach
Conclusion: This classification gives an organized approach in managing patients with dyspnea. It predicts that patients with alveolar defect-consolidation are most sick of all the groups and need immediate intervention. (Source: Indian Journal of Critical Care Medicine)
Source: Indian Journal of Critical Care Medicine - November 19, 2018 Category: Intensive Care Authors: Saurabh Saigal Rajnish Joshi Jai Prakash Sharma Vandana Pandey Abhijit Pakhare Source Type: research

Point-of-care ultrasound to evaluate thickness of rectus femoris, vastus intermedius muscle, and fat as an indicator of muscle and fat wasting in critically ill patients in a multidisciplinary intensive care unit
Conclusions: There is potential utility of ultrasound for early detection and probable corrective measures to prevent ICUAW. The rectus femoris thickness, skin to bone, and bone to muscle thickness show statistically significant difference on day 3, day 7 compared to day 1. Fat layer did not show statistically significant decrease. (Source: Indian Journal of Critical Care Medicine)
Source: Indian Journal of Critical Care Medicine - November 19, 2018 Category: Intensive Care Authors: Yeshaswini Katari Rangalakshmi Srinivasan Priyadarshini Arvind Sahajananda Hiremathada Source Type: research

Nutrition management of acute postliver transplant recipients
Conclusion: There are scant data on nutrition management in acute post-LT phase. The present study provides the framework for the formulation of continuous, patient-centric, aggressive nutrition management interventions for acute post-LT recipients. (Source: Indian Journal of Critical Care Medicine)
Source: Indian Journal of Critical Care Medicine - November 19, 2018 Category: Intensive Care Authors: Neha Bakshi Kalyani Singh Source Type: research

Cumulative fluid balance and outcome of extubation: A prospective observational study from a general intensive care unit
Conclusions: Our result validates the association between higher cumulative fluid balance and extubation failure in an Indian ICU. A future randomized control trial may examine any role of therapeutic diuresis/ultrafiltration in preventing failed extubation in patients who fulfill the readiness to wean criteria with cumulative net fluid balance ≥3490 ml. (Source: Indian Journal of Critical Care Medicine)
Source: Indian Journal of Critical Care Medicine - November 19, 2018 Category: Intensive Care Authors: Supradip Ghosh Aayush Chawla Kirtee Mishra Ranupriya Jhalani Ripenmeet Salhotra Amandeep Singh Source Type: research

Targeting the venous confluence of pirogoff for central venous cannulation insertion, when internal jugular vein cannulation is difficult: A three-step approach
Deepanshu Dhiman, Vikas Saini, Sameer Sethi, Tanvir SamraIndian Journal of Critical Care Medicine 2018 22(10):760-761 (Source: Indian Journal of Critical Care Medicine)
Source: Indian Journal of Critical Care Medicine - October 17, 2018 Category: Intensive Care Authors: Deepanshu Dhiman Vikas Saini Sameer Sethi Tanvir Samra Source Type: research

& #8220;BROAD effect: Bradycardia in obstructive airway disease & #8221;An unusual phenomenon: A case report
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. The mechanisms leading to such an event are poorly understood. To the best of our knowledge, it's the first case to be reported from India. (Source: Indian Journal of Critical Care Medicine)
Source: Indian Journal of Critical Care Medicine - October 17, 2018 Category: Intensive Care Authors: Vikas Sikri Vinay Singhal Sandeep Chopra Source Type: research

Artesunate-induced severe autoimmune hemolytic anemia in complicated malaria
Sarvinder Singh, Santosh Kumar Singh, Ajai Kumar Tentu, Anshu Kumar, Bhaskar Shahbabu, Vani Singh, Nidhi SinghIndian Journal of Critical Care Medicine 2018 22(10):753-756Autoimmune 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&#...
Source: Indian Journal of Critical Care Medicine - October 17, 2018 Category: Intensive Care Authors: Sarvinder Singh Santosh Kumar Singh Ajai Kumar Tentu Anshu Kumar Bhaskar Shahbabu Vani Singh Nidhi Singh Source Type: research

Refractory status asthmaticus: A case for unconventional therapies
We present successful use of Extracorporeal Membrane Oxygenation and isoflurane in a child with Refractory Status Asthmaticus. (Source: Indian Journal of Critical Care Medicine)
Source: Indian Journal of Critical Care Medicine - October 17, 2018 Category: Intensive Care Authors: Rohit Vohra Anil Sachdev Dhiren Gupta Neeraj Gupta Suresh Gupta Source Type: research

Anti-voltage-gated potassium channel antibody syndrome: A rare cause of hyponatremia in intensive care unit
Sulakshana Sulakshana, Shashi PrakashIndian Journal of Critical Care Medicine 2018 22(10):746-748Hyponatremia 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...
Source: Indian Journal of Critical Care Medicine - October 17, 2018 Category: Intensive Care Authors: Sulakshana Sulakshana Shashi Prakash Source Type: research

Calming the electrical storm: Use of stellate ganglion block and thoracic epidural in intractable ventricular tachycardia
Supriya D'souza, Shalini Saksena, Manju ButaniIndian Journal of Critical Care Medicine 2018 22(10):743-745Imbalances 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. (Source: Indian Journal of Critical Care Medicine)
Source: Indian Journal of Critical Care Medicine - October 17, 2018 Category: Intensive Care Authors: Supriya D ' souza Shalini Saksena Manju Butani Source Type: research

Methotrexate-induced toxic epidermal necrolysis: A rare case report and review of literature
Pritam Kataria, Pradip Kendre, Apurva Patel, Nahush Tahiliani, Sushant IkharIndian Journal of Critical Care Medicine 2018 22(10):740-742Acute 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 incl...
Source: Indian Journal of Critical Care Medicine - October 17, 2018 Category: Intensive Care Authors: Pritam Kataria Pradip Kendre Apurva Patel Nahush Tahiliani Sushant Ikhar Source Type: research

Bilateral phrenic nerve palsy in a diabetic causing respiratory failure
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. (Source: Indian Journal of Critical Care Medicine)
Source: Indian Journal of Critical Care Medicine - October 17, 2018 Category: Intensive Care Authors: Robert Da Costa Pezad Doctor Kaustubh Mahajan Vidyadhara G Lakkappan Source Type: research

Diagnostic usefulness of serum albumin as a predictor of diabetic ketoacidosis
Conclusions: Serum albumin levels may predict the occurrence of ketosis in diabetic patients. (Source: Indian Journal of Critical Care Medicine)
Source: Indian Journal of Critical Care Medicine - October 17, 2018 Category: Intensive Care Authors: Jayagowri Karthikeyan Sujatha Rajaragupathy Source Type: research

Timing of renal replacement therapy in acute kidney injury: Shedding new light on an old controversy
Helmut SchifflIndian Journal of Critical Care Medicine 2018 22(10):730-732Critically 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 spontane...
Source: Indian Journal of Critical Care Medicine - October 17, 2018 Category: Intensive Care Authors: Helmut Schiffl Source Type: research

A multicentric, prospective, observational antibacterial utilization study in Indian tertiary referral centers
Conclusions: More generic prescriptions and more number of prescriptions as per the sensitivity pattern are required at each public and private hospital. (Source: Indian Journal of Critical Care Medicine)
Source: Indian Journal of Critical Care Medicine - October 17, 2018 Category: Intensive Care Authors: 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 Source Type: research

Clinical and laboratory features associated with acute kidney injury in severe malaria
Conclusion: P. vivax is an important cause of severe malaria with AKI in our setting. Various other clinical features are associated with AKI and related mortality. (Source: Indian Journal of Critical Care Medicine)
Source: Indian Journal of Critical Care Medicine - October 17, 2018 Category: Intensive Care Authors: Hiren Anghan Prayas Sethi Manish Soneja Sandeep Mahajan Naveet Wig Source Type: research

Spectrum of diseases/conditions exhibiting hemostatic abnormalities in patients admitted to a medical intensive care unit of a tertiary care hospital
Conclusions: Tropical diseases formed the majority of admissions with bleeding manifestations. Thrombocytopenia is an important marker to predict mortality and also has a significant association with MICU stay. APACHE II score was found to be a good predictor of blood transfusion requirements. (Source: Indian Journal of Critical Care Medicine)
Source: Indian Journal of Critical Care Medicine - October 17, 2018 Category: Intensive Care Authors: Girish Chandrakant Rajadhyaksha Ameena Meah Source Type: research

Critical illness scoring systems: Sequential organ failure assessment, Acute Physiology and Chronic Health Evaluation II, and quick sequential organ failure assessment to predict the clinical outcomes in scrub typhus patients with organ dysfunctions
Conclusion: Among the three CISSs studied, the SOFA score correlated with in-hospital stay duration and mortality, whereas the qSOFA score formed a simple as well as a convenient tool in predicting the mortality in patients of cST with organ dysfunction. (Source: Indian Journal of Critical Care Medicine)
Source: Indian Journal of Critical Care Medicine - October 17, 2018 Category: Intensive Care Authors: Prasanth Balasubramanian Navneet Sharma Manisha Biswal Ashish Bhalla Susheel Kumar Vivek Kumar Source Type: research

Early pH change predicts intensive care unit mortality
Conclusions: Metabolic acidosis is associated with higher mortality in ICU. The rate of change in pH may better predict ICU mortality than other metabolic indices. (Source: Indian Journal of Critical Care Medicine)
Source: Indian Journal of Critical Care Medicine - October 17, 2018 Category: Intensive Care Authors: Sujay Samanta Ratender Kumar Singh Arvind K Baronia Prabhaker Mishra Banani Poddar Afzal Azim Mohan Gurjar Source Type: research

Clinical profile and outcome of patients with acute poisoning admitted in intensive care unit of tertiary care center in Eastern Nepal
Conclusion: Organophosphorous poisoning was the most common acute poisoning in young population leading to the ICU admission. Older age, delayed initiation of the resuscitative measures, need for mechanical ventilation, and hepatic failure significantly affected the mortality. (Source: Indian Journal of Critical Care Medicine)
Source: Indian Journal of Critical Care Medicine - October 17, 2018 Category: Intensive Care Authors: Lalit Kumar Rajbanshi Batsalya Arjyal Rakesh Mandal Source Type: research

Organ donation rate in brain-dead patients in a tertiary referral center
Shivakumar Mutnal, Pradeep Rangappa, Ipe Jacob, Karthik RaoIndian Journal of Critical Care Medicine 2018 22(9):685-686 (Source: Indian Journal of Critical Care Medicine)
Source: Indian Journal of Critical Care Medicine - September 17, 2018 Category: Intensive Care Authors: Shivakumar Mutnal Pradeep Rangappa Ipe Jacob Karthik Rao Source Type: research

Echographic comparison of optic nerve sheath diameter between both eyes
Maddalena De Bernardo, Ilaria De PascaleIndian Journal of Critical Care Medicine 2018 22(9):684-684 (Source: Indian Journal of Critical Care Medicine)
Source: Indian Journal of Critical Care Medicine - September 17, 2018 Category: Intensive Care Authors: Maddalena De Bernardo Ilaria De Pascale Source Type: research

Speech and swallowing function outcome following early tracheostomy in patients who underwent neurosurgical intervention
Pralay Shankar Ghosh, Sukanya Naskar, Afzal AzimIndian Journal of Critical Care Medicine 2018 22(9):683-683 (Source: Indian Journal of Critical Care Medicine)
Source: Indian Journal of Critical Care Medicine - September 17, 2018 Category: Intensive Care Authors: Pralay Shankar Ghosh Sukanya Naskar Afzal Azim Source Type: research

Verapamil as an adjuvant treatment for drug-resistant epilepsy
S Lakshmikanthcharan, Mohamed Hisham, SK Chaitanya Juluri, Sivakumar Mundilipayalam NandakumarIndian Journal of Critical Care Medicine 2018 22(9):680-682 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-glycoprot...
Source: Indian Journal of Critical Care Medicine - September 17, 2018 Category: Intensive Care Authors: S Lakshmikanthcharan Mohamed Hisham SK Chaitanya Juluri Sivakumar Mundilipayalam Nandakumar Source Type: research

A rare case of localized tetanus
We present case of a 55-year-old male farmer, presented with an injury to the left toe. A surgical wound exploration and washout with administration of human tetanus immunoglobulin and tetanus toxoid were given as treatment with antibiotic support. This case report points out the importance of the early recognition of a rare form of this fatal infectious disease, which may present with prodromal symptoms before the generalized form shows its clinical effects. Successful management includes prompt diagnosis, neutralization of circulating toxin and elimination of C. tetani infection, control of spasms, maintenance of the air...
Source: Indian Journal of Critical Care Medicine - September 17, 2018 Category: Intensive Care Authors: Deepak S Sharma Mit B Shah Source Type: research

Severe hypokalemia mimicking brain death
Asif Ali Hitawala, Piyush Garg, Abhay Jain, Ashish NaharIndian Journal of Critical Care Medicine 2018 22(9):674-677 We discuss a case of a 20-year-old female who presented with history of fever, vomiting, and decreased oral intake for 10 days followed by one episode of generalized tonic–clonic seizure and altered sensorium for 5–6 h. On arrival in the emergency room, she had Glasgow Coma Scale 3 (E1V1M1), both pupils fixed and dilated, low blood pressure, low oxygen saturation, and few gasping breaths. She appeared to be brain dead and was assumed to have a very poor prognosis. Investigations revealed severe h...
Source: Indian Journal of Critical Care Medicine - September 17, 2018 Category: Intensive Care Authors: Asif Ali Hitawala Piyush Garg Abhay Jain Ashish Nahar Source Type: research