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   Table of Contents - Current issue
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February 2017
Volume 21 | Issue 2
Page Nos. 69-113

Online since Monday, February 13, 2017

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RESEARCH ARTICLES  

A comparison of residents' knowledge regarding the surviving sepsis campaign 2012 guideline p. 69
Onnicha Suntornlohanakul, Bodin Khwannimit
DOI:10.4103/ijccm.IJCCM_282_16  
Background: Recently, Surviving Sepsis Campaign (SSC) guideline was updated. Our objective was to evaluate the knowledge of residents in different departments regarding the SSC 2012. Methods: A cross-sectional, descriptive self-questionnaire was distributed to interns and residents in the Departments of Internal Medicine, Surgery, and Emergency Medicine. Results: The response rate was 136 (89%) from 153 residents. The residents included 46 (33%) interns, 42 (31%) internal medicine residents, 41 (30%) surgical residents, and 7 (5%) emergency residents. Regarding the definitions of severe sepsis and septic shock, only 44 (32.4%) residents were able to differentiate the severity of sepsis. The surgical residents had a significantly lower rate of correct answers than that of internal medicine residents (12.2% vs. 45.2, P= 0.001), emergency residents (12.2% vs. 57.1%, P = 0.005), and interns (12.2% vs. 34.8%, P = 0.014). Only 77 (51.5%) residents would measure blood lactate in patients with sepsis. In respect to the dose of fluid resuscitation, only 72 (52.9%) residents gave the recommended fluid (30 ml/kg) within the first 3 h. Surgical residents had a significantly lesser percentage of correct answers than that of internal medicine residents (29.3% vs. 69%, P < 0.0001) and interns (29.3% vs. 60.8%, P = 0.003). About 123 (90.4%) and 115 (84.6%) residents knew the appropriate targets for mean arterial pressure and vasopressors, respectively. Most residents could give antimicrobial drugs (73.5%) and steroids (93.4%) appropriately in the treatment of patients with septic shock. However, only half of the residents knew the target range of blood sugar control in patients with sepsis. Conclusions: Our residents' knowledge about the SSC 2012 is not satisfactory. Further instruction concerning sepsis management is required.
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Early administration of selenium in patients with acute traumatic brain injury: A randomized double-blinded controlled trial Highly accessed article p. 75
Omid Moradi Moghaddam, Mohammad Niakan Lahiji, Valiollah Hassani, Shakiba Mozari
DOI:10.4103/ijccm.IJCCM_391_16  
Aim: The present study was carried out to examine this hypothesis that administration of selenium can prevent the development of injuries by brain trauma and thus can modulate patients' functional recovery and also improve posttraumatic outcome. Materials and Methods: This double-blinded controlled trial was carried out on 113 patients who were hospitalized following traumatic brain injury (TBI) with Glasgow Coma Scale score of 4–12 that were randomly assigned to receive selenium within 8 h after injury plus standard treatment group or routine standard treatment alone as the control. The primary endpoint was to assess patients' functional recovery at 2 months after the injury based on extended Glasgow Outcome Scale score (GOS-E). Secondary outcomes included the changes in Full Outline of Unresponsiveness score (FOUR) score, Sequential Organ Failure Assessment (SOFA) score, and acute physiology and chronic health evaluation (APACHE) III score, side effects of selenium, length of Intensive Care Unit (ICU) stay, and length of hospital stay. Results: There was no difference in the length of ICU and hospital stay, the trend of the change in FOUR and SOFA scores within 15 days of first interventions, and the mean APACHE III score on the 1st and 15th days between the two groups. Mortality was 15.8% in selenium group and 19.6% in control group with no between-group difference. No difference was revealed between the two groups in appropriate outcome according to GOS-E score at 60 ± 10 days and also 30 ± 5 days according to the severity of TBI. Conclusion: This human trial study could not demonstrate beneficial effects of intravenous infusion of selenium in the improvement of outcomes in patients with acute TBI.
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Safety and efficacy of a single dose of Anti-D (WinRho®) in severe thrombocytopenia secondary to dengue virus infection p. 80
Ashok Kumar Pannu, Ashish Bhalla, Mayank Singhal, Vikas Suri, Nusrat Shafiq, Subhash Varma
DOI:10.4103/ijccm.IJCCM_386_16  
Objective: To evaluate the efficacy of a single intravenous (IV) dose of anti-D in severe thrombocytopenia (<20,000) due to dengue virus (DEV) infection. Materials and Methods: An open label, investigator-initiated, randomized interventional study was conducted that included thirty dengue patients (all positive for IgM enzyme-linked immunosorbent assay) with severe thrombocytopenia (<20,000/mm3). Patients were randomized to receive anti-D (50 μg/kg single IV dose) plus supportive therapy or supportive therapy alone. Results: The rate of rise in platelet count was significantly high in the intervention group at 24, 36, and 48 h. At the end of 48 h, 60% patients in the intervention group achieved a platelet count of ≥50,000/mm3 as compared to 6.7% in the control group (P = 0.0019). The requirement of the platelet concentrate infusion in the control group was significantly higher, i.e. 342 ml (±193) as compared to the intervention group requiring only 187 ml (±79). The intervention group showed a significant improvement in bleeding manifestations in all the patients by 24 h in Grade 2 bleed (P = 0.032) and by 48 h in Grade 1 bleed (P = 0.014). Conclusions: Severe thrombocytopenia (≤20,000/mm3) secondary to DEV infection was rapidly and safely reversed by administration of a single dose of 50 μg/kg (250 IU/kg) anti-D IV.
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BRIEF COMMUNICATIONS Top

Comparative assessment of patient care expenses among intensive care units of a tertiary care teaching hospital using cost block method p. 85
Kanakavalli Kiranmai Kundury, HK Mamatha, Divya Rao
DOI:10.4103/ijccm.IJCCM_276_16  
Introduction: Intensive care services of a hospital are found to consume major chunk of hospital resources as well draining the savings of patients. Implementing proper control measures facilitates effective functioning of critical care services. Aim: Identify various costs involved in operating Surgical Intensive Care Unit (SICU) and Respiratory Intensive Care Unit (RICU); also find out the running cost of the same. Methodology: Retrospective data was collected for 12 months period and prospectively through informal interactions with staff. Results: Construction and estate costs of the respective ICU's were found to be high, followed by laboratory charges. Running cost of RICU was found to be more than SICU. Conclusion: Costing of intensive care service is essential for controlled operations and to provide efficient patient care.
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Quality of life improves with individualized home-based exercises in critical care survivors p. 89
Aayushi G Shelly, Nivedita S Prabhu, Priyanka Jirange, Asha Kamath, K Vaishali
DOI:10.4103/ijccm.IJCCM_433_16  
The Aim of the Study: This study aims to determine the effect of individualized home-based exercise on the quality of life post-Intensive Care Unit (ICU) discharge. Subjects: Adult patients invasively mechanically ventilated for more than 48 h in medical ICU. Methodology: Thirty-five patients were enrolled prospectively in this study. They were interviewed to complete short form 36 (SF-36) version 2 questionnaire and were randomly allocated to control and experimental group by block randomization. The experimental group received individualized exercise information sheet and control group was asked to continue routine exercises done during their hospital stay. The experimental group also received a log book and weekly telephonic reminders. Patients were interviewed to complete the SF-36 through the telephone 4 weeks after hospital discharge. Results: Physical and mental components of the quality of life as measured by the SF-36 at the end of 4 weeks after hospital discharge showed a statistically significant difference (P < 0.05) in the experimental group. Conclusion: A well-structured individualized exercise program improves the quality of life of critically ill patients after discharge.
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CASE REPORTS Top

Airway complications of total artificial heart p. 94
Vikas Pathak, Colin Donovan, Rajiv Malhotra
DOI:10.4103/ijccm.IJCCM_329_16  
The total artificial heart is the mechanical device which is used as a bridge to the heart transplant in patients with biventricular failure. Due to the mechanical nature of the device, patients receiving total artificial heart (TAH) require to be on anticoagulation therapy. Hemorrhage and coagulopathy are few of the known complications of TAH.
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Successful removal of foreign body bronchus using C-arm-guided insertion of fogarty catheter through plastic bead p. 96
Ravindra Ganuji Wankhede, Gaurab Maitra, Subhabrata Pal, Anirban Ghoshal, Soumen Mitra
DOI:10.4103/ijccm.IJCCM_148_16  
Foreign body aspiration is still a cause of significant morbidity in children. Complications occur due to difficulty in diagnosis and treatment. An eight-year-old child presented with a history of recurrent cough for 3 days. Rigid bronchoscopy under general anesthesia revealed plastic bead occupying right main bronchus. Removal with grasping forceps failed for several times due to spherical, smooth, and large bead. Finally, Fogarty catheter was passed through bead under C-arm guidance and successfully removed.
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Severe hypothermia causing ventricular arrhythmia in organophosphorus poisoningkartik munta, Paiullah Santosh, Manimala Rao Surath p. 99
Kartik Munta, Paiullah Santosh, Manimala Rao Surath
DOI:10.4103/ijccm.IJCCM_443_16  
Organophosphorus poisoning cases are routinely treated across all Intensive Care Units adjoining the rural areas where agriculture is the main source of income. We present a unique case of severe hypothermia seen in a case of organophosphorus poisoning, which led to electrocardiogram disturbances and life-threatening arrhythmias.
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Complements spurned: Our experience with atypical hemolytic uremic syndrome p. 102
Vidya S Nagar, Rudrarpan Chaterjee, Ankita Sood, Basavaraj Sajjan, Aniruddha Kaushik, Sameer V Vyahalkar
DOI:10.4103/ijccm.IJCCM_341_16  
Atypical hemolytic uremic syndrome (aHUS) is a rare disorder resulting from a dysregulated activation of the alternative pathway of the complement system. It results in significant morbidity and mortality if not diagnosed and treated promptly. It lends itself to myriad renal and extrarenal manifestations, all potentially disabling. Eculizumab, a monoclonal antibody to complement C5 is now the widely accepted norm for treatment. However, in resource-limited settings, plasma exchange if instituted early may be as beneficial. We report a case of aHUS treated with extended plasma exchange with excellent results. Critical care monitoring is essential for the management of the disease in view of a tendency to develop multiple complications. Long-term immunosuppression may be successful in maintaining remission.
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Role of magnetic resonance imaging in diagnosing neurological complications in intermediate syndrome of organophosphate poisoning p. 105
Reddy Ravikanth
DOI:10.4103/ijccm.IJCCM_357_16  
Organophosphate poisoning (OP) is a very common mode of suicide in rural and urban areas due to the wide availability of pesticides. The identification of OP and timely referral for appropriate supportive care can be lifesaving. Injury to the central nervous system is a serious entity in acute OP. Application of modern imaging techniques like diffusion weighted imaging increases the diagnostic rate of brain injury in the early period and can provide evidence for medical treatment. We present the imaging features in the intermediate syndrome of OP.
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A rare cause of pulmonary edema in the postoperative period p. 108
Kshitij Chatterjee, Penchala S Mittadodla, Clinton Colaco, Rajani Jagana
DOI:10.4103/ijccm.IJCCM_495_15  
With the increasing longevity of the population, the annual rates of hip arthroplasties performed have been steadily increasing over the past decade. Given the presence of medical comorbidities in the older patients, the peri-operative care of these individuals requires multi-specialty care, now more than ever. Hip arthroplasty is generally well tolerated, with early mortality after the procedure being <1%. Bone cement implantation syndrome (BCIS) is an entity that is occasionally encountered during or after the surgery. It is characterized by hypoxemia, hypotension, cardiac arrhythmias, and cardiac arrest leading to death, in severe cases. We report a case of a middle-aged female who developed refractory hypotension and pulmonary edema while undergoing hemiarthroplasty for a pathological femoral neck fracture and experienced cardiac arrest in the immediate postoperative period. Critical care physicians must familiarize themselves with promptly diagnosing and managing BCIS.
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LETTERS TO THE EDITOR Top

Bent guide wire of central venous catheter p. 110
Monish S Raut, Priyanka Gupta, Sandeep Joshi, Arun Maheshwari
DOI:10.4103/ijccm.IJCCM_114_15  
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The impact of early tracheostomy in neurotrauma patients: A retrospective study p. 111
Sai Saran, Pralay Ghosh, Afzal Azim
DOI:10.4103/ijccm.IJCCM_31_17  
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Complications and benefits of intrahospital transport of adult intensive care unit patients p. 112
MM Harish, S Janarthanan, SS Siddiqui, Harish K Chaudhary, NR Prabu, Jigeeshu Vashistha Divatia, Atul Prabhakar Kulkarni
DOI:10.4103/ijccm.IJCCM_26_17  
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Intensive care unit psychosis-sundowning: A challenging phenomenon p. 112
Salman Assad, Usman Ghani, Touqeer Sulehria, Taimur Mansoor, Muhammad Atif Ameer
DOI:10.4103/0972-5229.200008  
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