Indian Journal of Critical Care Medicine

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Volume 28, Number 6, June 2024
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EDITORIAL

Sameera Hajijama, Deven Juneja, Prashant Nasa

Large Language Model in Critical Care Medicine: Opportunities and Challenges

[Year:2024] [Month:June] [Volume:28] [Number:6] [Pages:3] [Pages No:523 - 525]

Keywords: Artificial, Artificial intelligence, Artificial neural network, Critical care medicine, Healthcare, Intelligence

   DOI: 10.5005/jp-journals-10071-24743  |  Open Access |  How to cite  | 

208

EDITORIAL

Ajith Kumar AK, Justin A Gopaldas

Micronutrient Changes in Critically Ill: Elusive Answers for Evaluation and Management

[Year:2024] [Month:June] [Volume:28] [Number:6] [Pages:3] [Pages No:526 - 528]

Keywords: Iron profile, Micronutrient, Mortality, Sepsis, Vitamin D

   DOI: 10.5005/jp-journals-10071-24738  |  Open Access |  How to cite  | 

229

EDITORIAL

Rohit Patnaik, Nupur Karan

Synergizing Survival: Uniting Acute Gastrointestinal Injury Grade and Disease Severity Scores in Critical Care Prognostication

[Year:2024] [Month:June] [Volume:28] [Number:6] [Pages:2] [Pages No:529 - 530]

Keywords: Acute gastrointestinal injury, APACHE II score, Disease severity scores, mNUTRIC score, Mortality prediction, Prognostication, SAPS II Score, SOFA score

   DOI: 10.5005/jp-journals-10071-24735  |  Open Access |  How to cite  | 

187

EDITORIAL

Sachin Gupta, Deeksha S Tomar

Am I Sedated or in Pain? Please Monitor by Brain

[Year:2024] [Month:June] [Volume:28] [Number:6] [Pages:2] [Pages No:531 - 532]

Keywords: Fentanyl, Ketamine, Quantium index

   DOI: 10.5005/jp-journals-10071-24744  |  Open Access |  How to cite  | 

187

COMMENTARY

Farhad Kapadia, Shreya Bharadwaj, Ritika Sharma

Is “Less be More” Still a Valid Concept in Intensive Care? A Review of Critical Care Randomized Clinical Trials from the New England Journal of Medicine

[Year:2024] [Month:June] [Volume:28] [Number:6] [Pages:19] [Pages No:533 - 551]

Keywords: Clinical outcomes, Less is more, Mortality in randomized clinical trials

   DOI: 10.5005/jp-journals-10071-24717  |  Open Access |  How to cite  | 

Abstract

The concept of “Less is more” has been gaining increasing awareness and acceptance in Critical Care. In 2017, we attempted to systematically answer the question “Can less be more in intensive care” with empirical data. We reviewed all the critical care randomized clinical trials (RCTs) between 1 January 2008 and 5 October 2016 in the New England Journal of Medicine (NEJM). This article attempts to repeat the earlier exercise using data from 5 October 2016 to 31 December 2023. This analysis of critical care RCTs in the NEJM has shown three findings. Approximately three-quarter of RCTs in critical care in the NEJM between 2008 and 2023 failed to show benefit or harm. In the years 2008–2016, patients in the intervention cohort had a higher mortality compared to controls, but in the years 2016–2023, the difference in overall mortality in patients in the intervention and control arms was not statistically significant. Compared to the years 2008–2016, in the years from 2016 to 2023, the number of RCTs showing harm decreased and those showing benefit increased.

295

PROTOCOL

Sumalatha Arunachala, Sindhuja Devapal, Dayana Shre N Swamy, Mandya V Greeshma, Imaad Ul Hussain, Jayaraj B Siddaiah, Devasahayam J Christopher, Sowmya Malamardi, Mohammed Kaleem Ullah, Mohammed Saeed, Ashwaghosha Parthasarathi, J Jeevan, Jeevan Kumar, N Harsha, Laxmegowda, Chetak K Basavaraj, Pongali B Raghavendra, Komarla S Lokesh, L Nischal Raj, DK Suneetha, MM Basavaraju, R Madhu Kumar, H Basavanagowdappa, MN Suma, Prashanth M Vishwanath, Suresh Babu, P Ashok, Tandure Varsha, Shreya Chandran, Hariharan Venkataraman, Dinesh HN, Skanda Swaroop, Koustav Ganguly, Swapna Upadhyay, Padukudru A Mahesh

Factors Affecting Survival in Severe and Very Severe COPD after Admission in ICUs of Tertiary Care Centers of India (FAST COPD): Study Protocol for a Multicentric Cohort Study

[Year:2024] [Month:June] [Volume:28] [Number:6] [Pages:9] [Pages No:552 - 560]

Keywords: Acute exacerbation, Intensive care unit, Malnutrition, Morbidity, Obesity, Phenotypes, Severe and very severe COPD, Survival

   DOI: 10.5005/jp-journals-10071-24728  |  Open Access |  How to cite  | 

Abstract

Background: Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality worldwide. However, there is a lack of comprehensive data from low- and middle-income countries (LMICs) regarding factors influencing COPD outcomes, particularly in regions where biomass exposure is prevalent. Objective: The Factors Affecting Survival in Severe and Very Severe COPD Patients Admitted to Tertiary Centers of India (FAST) study aims to address this gap by evaluating factors impacting survival and exacerbation rates among COPD patients in LMICs like India, with a specific focus on biomass exposure, clinical phenotypes, and nutritional status in patients admitted to the Intensive Care Unit (ICU). Methods: The FAST study is an observational cohort study conducted in university teaching hospitals across India. The study aims to enroll 1000 COPD patients admitted to the ICU meeting specific inclusion criteria, with follow-up assessments conducted every 6 months over a 2-year period. Data collection includes demographic information, clinical manifestations, laboratory investigations, pulmonary function tests, medications, nutritional status, mental health, and health-related quality of life. Adjudication of exacerbations and mortality will also be undertaken. The FAST study seeks to provide crucial insights into COPD outcomes in LMICs, informing more precise management strategies and mitigating the burden of COPD in these settings. By evaluating factors such as biomass exposure, clinical phenotypes, and nutritional status, the study aims to address key knowledge gaps in COPD research.

182

Original Article

Prakash G Gondode, Puneet Khanna, Pradeep Sharma, Sakshi Duggal, Neha Garg

End-of-life Care Patient Information Leaflets—A Comparative Evaluation of Artificial Intelligence-generated Content for Readability, Sentiment, Accuracy, Completeness, and Suitability: ChatGPT vs Google Gemini

[Year:2024] [Month:June] [Volume:28] [Number:6] [Pages:8] [Pages No:561 - 568]

Keywords: Artificial intelligence, ChatGPT, End-of-life care, Gemini, Intensive care, Palliative care, Patient education, Readability

   DOI: 10.5005/jp-journals-10071-24725  |  Open Access |  How to cite  | 

Abstract

Background: End-of-life care (EOLC) is a critical aspect of healthcare, yet accessing reliable information remains challenging, particularly in culturally diverse contexts like India. Objective: This study investigates the potential of artificial intelligence (AI) in addressing the informational gap by analyzing patient information leaflets (PILs) generated by AI chatbots on EOLC. Methodology: Using a comparative research design, PILs generated by ChatGPT and Google Gemini were evaluated for readability, sentiment, accuracy, completeness, and suitability. Readability was assessed using established metrics, sentiment analysis determined emotional tone, accuracy, and completeness were rated by subject experts, and suitability was evaluated using the Patient Education Materials Assessment Tool (PEMAT). Results: Google Gemini PILs exhibited superior readability and actionability compared to ChatGPT PILs. Both conveyed positive sentiments and high levels of accuracy and completeness, with Google Gemini PILs showing slightly lower accuracy scores. Conclusion: The findings highlight the promising role of AI in enhancing patient education in EOLC, with implications for improving care outcomes and promoting informed decision-making in diverse cultural settings. Ongoing refinement and innovation in AI-driven patient education strategies are needed to ensure compassionate and culturally sensitive EOLC.

388

Original Article

Mukesh Bairwa, Basavaraj Jatteppanavar, Ravi Kant, Mahendra Singh, Arnab Choudhury

Impact of Iron Profile and Vitamin D Levels on Clinical Outcomes in Patients with Sepsis and Septic Shock: A Cross-sectional Analysis at a Tertiary Care Center

[Year:2024] [Month:June] [Volume:28] [Number:6] [Pages:6] [Pages No:569 - 574]

Keywords: Acute physiology and chronic health evaluation II, Ferritin, Iron profile, Mortality, Sepsis, Septic shock, SOFA score, Transferrin saturation, Vitamin D levels

   DOI: 10.5005/jp-journals-10071-24726  |  Open Access |  How to cite  | 

Abstract

Aim and background: Sepsis is a major global health affecting millions worldwide, hence understanding its contributing factors becomes paramount. This cross-sectional study at a tertiary care center explores the relationship between iron profile, vitamin D levels, and outcomes in sepsis and septic shock patients. The primary objective was to explore the prevalence of iron profile and vitamin D parameters during early intensive care unit (ICU) admission and their association with 28-day mortality. Materials and methods: Spanning 18 months, the study enrolled adult patients meeting sepsis or septic shock criteria at the ICU. Data collection included demographic information, clinical characteristics, and blood samples for iron profile and vitamin D levels at admission. Disease severity was assessed using sequential organ failure assessment (SOFA) and acute physiology and chronic health evaluation II (APACHE II) scores, and treatment was administered as per surviving sepsis-3 guidelines. Results: The research involved 142 participants, uncovering prevalent organisms such as Acinetobacter baumannii, Pseudomonas aeruginosa, and Klebsiella pneumoniae. Noteworthy connections to mortality were identified for factors including vasopressor support, ICU stay duration, SOFA score, and APACHE-II score. Interestingly, age, gender, and vitamin D levels showed no significant associations. However, the study did reveal a significant association between iron, ferritin, and transferrin saturation levels with increased 28-day mortality. Conclusion: Our study concluded that low Iron, elevated ferritin, and decreased transferrin saturation levels maintained associations with the outcome of interest. While no such relationship was established with vitamin D levels. These results suggest potential implications for patient management and prognosis, warranting further exploration in future research.

204

Original Article

Pham D Hai, Nguyen H Tot, Le T Thao, Quy Khoa, Dang H Thien

Prognostic Value of Acute Gastrointestinal Injury Combined with Disease Severity Scores in Critically Ill Patients

[Year:2024] [Month:June] [Volume:28] [Number:6] [Pages:6] [Pages No:575 - 580]

Keywords: Acute gastrointestinal injury, Critically ill patients, Disease severity scores, mNUTRIC score, Prognosis

   DOI: 10.5005/jp-journals-10071-24733  |  Open Access |  How to cite  | 

Abstract

Background: Critically ill patients are at high risk of multiple organ failure syndrome (MODS) and gastrointestinal (GI) injury and dysfunction, which are associated with increased mortality rates. The acute gastrointestinal injury (AGI) scale has shown promise in assessing GI dysfunction. However, the combined utility of AGI with established disease severity scores remains unclear. This study aimed to investigate the performance of AGI in conjunction with modified nutritional risk in critically ill (mNUTRIC), sequential organ failure assessment (SOFA), and acute physiology and chronic health evaluation II (APACHE II) scores for predicting mortality in critically ill patients. Materials and methods: A retrospective cross-sectional study was conducted in the intensive care unit (ICU) from May 2021 to December 2021. Demographic and clinical data were collected, including AGI grade, mNUTRIC score, SOFA score, APACHE II score, and mortality. Results: Among 93 critically ill patients, AGI was observed in 47.3% of cases, and the in-hospital mortality rate was 30.1%. The area under the curve (AUC) for AGI in predicting in-hospital mortality was 0.67 [95% confidence interval (CI), 0.56, 0.79; p = 0.008], similar to the AUCs of SOFA, APACHE II, and mNUTRIC scores. The combination of AGI with mNUTRIC, APACHE II, or SOFA scores improved the predictive performance compared with AGI alone. Conclusion: The AGI grade, in conjunction with disease severity scores, such as mNUTRIC, SOFA, and APACHE II scores, shows promise in predicting mortality in critically ill patients. Integrating AGI into evaluating critically ill patients can enhance prognostic accuracy.

184

Original Article

Alegra R Masharto, Andriamuri P Lubis, Chrismas G Bangun, Arlinda S Wahyuni

Quantium Consciousness Index and Quantium Noxious Index in Ketamine Subdose Administration Compared with Fentanyl and Midazolam in Postoperative ICU Patients: A Prospective, Observational Study

[Year:2024] [Month:June] [Volume:28] [Number:6] [Pages:6] [Pages No:581 - 586]

Keywords: Fentanyl, Intensive care units, Ketamine, Midazolam, Postoperative, qCON, qNOX, Subdose

   DOI: 10.5005/jp-journals-10071-24734  |  Open Access |  How to cite  | 

Abstract

Aims and background: In postoperative patients in the intensive care units (ICUs), not only analgesics are needed but also sedation so that the patient can remain calm during treatment, especially patients with mechanical ventilation. By using the measurement parameters of the quantum consciousness index (qCON) and quantum noxious index (qNOX) in measuring the depth of sedation and adequacy of analgesics, the use of subdose ketamine instead of fentanyl and midazolam as sedative, analgesic agents can be performed as a new alternative to nociceptive monitoring methods with more objective results. This study aims to obtain results of comparing qCON and qNOX in postoperative patients by administering subdose ketamine compared with a combination of fentanyl and midazolam in RSUP Haji Adam Malik Medan. Materials and methods: A randomized clinical trial with a double-blind approach has been used in this study. A total of 44 experimental samples were gathered and randomly split into two groups after meeting the criteria for inclusion. Group A administered a ketamine subdose, whereas Group B administered a mixture of fentanyl and midazolam. The research data obtained were tested using Statistical Product and Science Service (SPSS). Results: There were differences in the median, minimum, and maximum values of qCON and qNOX in the groups given subdose ketamine and fentanyl and midazolam, but these were not statistically significant (p > 0.05) at T0, T1, and T2. Conclusion: Administering a subdose of ketamine can provide sedation and analgesia comparable to fentanyl and midazolam.

135

Original Article

Aravind Chandrasekaran, Divya Pal, Rahul Harne, Sweta J Patel, KN Jagadeesh, Anant V Pachisia, Pooja Tyagi, Keerti Brar, Swagat Pattajoshi, Parimal B Patel, Ronak Zatakiya, Deepak Govil

Comparison between Effect of Indirect Calorimetry vs Weight-based Equation (25 kcal/kg/day)-guided Nutrition on Quadriceps Muscle Thickness as Assessed by Bedside Ultrasonography in Medical Intensive Care Unit Patients: A Randomized Clinical Trial

[Year:2024] [Month:June] [Volume:28] [Number:6] [Pages:8] [Pages No:587 - 594]

Keywords: Caloric target, Critically ill, Indirect calorimetry, Intensive care unit–acquired weakness, Muscle wasting, Nutrition, Quadriceps muscle thickness, Sarcopenia, Ultrasound

   DOI: 10.5005/jp-journals-10071-24737  |  Open Access |  How to cite  | 

Abstract

Aim and background: Sarcopenia is a substantial contributor to intensive care unit (ICU)-acquired weakness and is associated with significant short- and long-term outcomes. It can, however, be mitigated by providing appropriate nutrition. Indirect calorimetry (IC) is believed to be the gold standard in determining caloric targets in the dynamic environment of critical illness. We conducted this study to compare the effect of IC vs weight-based (25 kcal/kg/day) feeding on quadriceps muscle thickness (QMT) by ultrasound in critically ill patients. Materials and methods: A prospective study was conducted on 60 mechanically ventilated patients randomized to two groups [weight-based equation (WBE) group or the IC group] in medical ICU after obtaining institutional ethics committee approval, and fed accordingly. The right QMT measurement using ultrasound and caloric targets were documented on day 1, 3 and 7 and analyzed statistically. The IC readings were obtained from the metabolic cart E-COVX ModuleTM. Results: The baseline demographics, APACHE-II, NUTRIC score, and SOFA scores on day 1, 3, and 7 were comparable between the two groups. The resting energy expenditure (REE) obtained in the IC group was significantly less than the WBE energy targets and the former were fed with significantly less calories. A significantly less percent reduction of QMT in the IC group compared with the WBE group was observed from day 1 to day 3, day 3 to day 7, and day 1 to day 7. Conclusion: From our study, we conclude that IC-REE-based nutrition is associated with lesser reduction in QMT and lesser calories fed in critically ill mechanically ventilated patients compared from WBE. CTRI registration-CTRI/2023/01/049119.

230

Original Article

Anuj Kumar, Alok K Bharti, Mumtaz Hussain, Sanjeev Kumar, Arvind Kumar

Correlation of Internal Jugular Vein and Inferior Vena Cava Collapsibility Index with Direct Central Venous Pressure Measurement in Critically-ill Patients: An Observational Study

[Year:2024] [Month:June] [Volume:28] [Number:6] [Pages:6] [Pages No:595 - 600]

Keywords: Central venous pressure, Critically ill patients, Inferior vena cava collapsibility index, Internal jugular vein, Volume status

   DOI: 10.5005/jp-journals-10071-24741  |  Open Access |  How to cite  | 

Abstract

Background and aims: Prompt assessments and quick replacement of intravascular fluid are critical steps to resuscitate hypovolemic patients. Intravascular volume assessment by direct central venous pressure (CVP) measurement is an invasive, time-consuming, and labor-intensive procedure. Nowadays, bedside ultrasound-guided volume assessment of the internal jugular vein (IJV) or inferior vena cava (IVC) is commonly employed as a proxy for direct CVP. Therefore, we examined the strength of association between CVP and collapsibility index (CI) of the IJV and IVC for evaluating the volume status of critically ill patients. Methods: Bedside USG-guided A–P diameter and cross-sectional area of the right IJV and IVC were measured, and their corresponding collapsibility indices were deduced. The results of the IJV and IVC indices were correlated with CVP. Results: About 60 out of 70 enrolled patients were analyzed. The baseline clinical parameters of patients are shown in Table 1. For CSA and AP diameter, the correlations between CVP and IJV-CI at 0° were r = –0.107 (p = 0.001) and r = –0.092 (p = 0.001). Correlations between CVP and IJV-CI at 30° for CSA and diameter, however, were (r = –0.109, p = 0.001) and (r = –0.117, p = 0.001), respectively. Table 2 depicts the correlation between CVP and IVC-CI r = –0.503, p = 0.001 for CSA and r = –0.452, p = 0.001 for diameter. Conclusion: The IVC and IJV collapsibility indices can be used in place of invasive CVP monitoring to assess fluid status in critically ill patients.

211

Original Article

Arun Prabhahar, Niranjan A Vijaykumar, Suresh Selvam, Raja Ramchandran, Jasmine Sethi, Ashok Pannu, Navneet Sharma

Characteristics and Prognosis of Infectious Disease Emergencies in Patients with Chronic Kidney Disease in India

[Year:2024] [Month:June] [Volume:28] [Number:6] [Pages:6] [Pages No:601 - 606]

Keywords: Chronic kidney disease, Emergency, Hemodialysis, Infections, Mortality, Pneumonia, Urinary tract infection

   DOI: 10.5005/jp-journals-10071-24731  |  Open Access |  How to cite  | 

Abstract

Objectives: Chronic kidney disease (CKD) significantly increases the risk of infectious diseases (IDs), leading to heightened morbidity and mortality. However, there remains a lack of detailed, region-specific studies. This study investigates the clinical spectrum, etiologies, outcomes, and baseline predictors of mortality of ID emergencies in CKD patients in North India. Methods: This retrospective study was conducted at the Postgraduate Institute of Medical Education and Research, Chandigarh, from January 2021 to December 2022. It included patients aged ≥13 years with CKD and IDs admitted to the Acute Care and Emergency Medicine Unit. Results: We enrolled 248 patients (mean age 50 years, 58.1% males). About 60% had CKD stage 5, and 46% were on maintenance hemodialysis. Diabetic kidney disease was the predominant etiology (38.7%). The principal IDs were pneumonia (27.4%), urinary tract infection (UTI) (21.4%), sepsis of unknown primary focus (15.7%), tuberculosis (8.1%), and multisite infections (7.7%). Patients commonly have atypical clinical presentation, e.g., absence of fever and nonspecific symptoms such as shortness of breath and altered mental status. An emergence of multidrug-resistant organisms, e.g., Enterococcus faecium for UTI and Stenotrophomonas maltophilia for catheter-related bloodstream infections, was noted. In-hospital mortality rate was 33.5%, higher with multisite infections (58%) and pneumonia (47%). A low baseline Glasgow coma scale (GCS) was an independent predictor of mortality [odds ratio (OR) 0.786, 95% confidence interval (CI) 0.693–0.891, p-value <0.001]. Conclusion: Effective management and early intervention are needed to improve outcomes in CKD patients with ID emergencies, given the high mortality and atypical clinical presentations.

177

Original Article

Adhiti Krishnamoorthy, Samuel G Hansdak, John V Peter, Kishore Pichamuthu, Sudha J Rajan, Thomas I Sudarsan, Sridhar Gibikote, Lakshmanan Jeyaseelan, Thambu D Sudarsanam

Incidence and Risk Factors for Deep Venous Thrombosis and Its Impact on Outcome in Patients Admitted to Medical Critical Care

[Year:2024] [Month:June] [Volume:28] [Number:6] [Pages:7] [Pages No:607 - 613]

Keywords: Cohort, Deep vein thrombosis, Intensive care unit, Mortality, Thromboprophylaxis

   DOI: 10.5005/jp-journals-10071-24723  |  Open Access |  How to cite  | 

Abstract

Objectives: This study evaluated the incidence and risk factors for deep venous thrombosis (DVT) while on thromboprophylaxis, in patients admitted to the medical intensive care unit (MICU), and to assess its impact on outcomes. Methods: Consecutive patients admitted to the MICU underwent compression ultrasound of the jugular, axillary, femoral, and popliteal veins at admission, day 3 and 7 to screen for DVT. All patients were on pharmacological and/or mechanical thromboprophylaxis as per protocol. The primary outcome was the incidence of DVT (defined as occurrence on day 3 or 7). Secondary outcomes were death and duration of hospitalization. Risk factors for DVT were explored using bivariate and multivariable logistic regression analysis and expressed as risk ratio (RR) with 95% confidence intervals (CIs). Results: The incidence of DVT was 17.2% (95% CI 12.0, 22.3) (n = 35/203); two-thirds were catheter associated (23/35). There was no difference in mortality between those with and without incident DVT (9/35 vs 40/168, p = 0.81). The mean (SD) duration of hospitalization was longer in the DVT group (20.1 (17) vs 12.9 (8.5) days, p = 0.007). Although day 3 INR (RR 2.1, 95% CI 0.9–5.3), age >40 years (2.1, 0.8–5.3), vasopressor use (1.0, 0.4–2.9) and SOFA score (0.9, 0.85–1.1) were associated with the development of DVT on bivariate analysis, only central venous catheters (15.97, 1.9–135.8) was independently associated with DVT on multivariable analysis. Conclusions: Despite thromboprophylaxis, 17% of ICU patients develop DVT. The central venous catheter is the main risk factor. DVT is not associated with increased mortality in the setting of prophylaxis.

222

SHORT COMMUNICATION

Bandita Panda, Nipa Singh, Gyanraj Singh, A Raj K Patro, Ambika P Mohanty, Pradeep K Patnaik, Ramnath Misra

RT-PCR Result of SARS-CoV-2 Viral RNA in Cadavers and Viral Transmission Risk to Handlers

[Year:2024] [Month:June] [Volume:28] [Number:6] [Pages:3] [Pages No:614 - 616]

Keywords: Cadaver, Pandemic, RT-PCR, SARS-CoV-2, Transmission risk

   DOI: 10.5005/jp-journals-10071-24730  |  Open Access |  How to cite  | 

Abstract

During the onset of the pandemic, a common research question was asked by the hospital staff, and family members who were handling COVID-19-infected cadavers, “does COVID-19-positive dead body harbor SARS-CoV-2 viral RNA?” Several research findings were reported but due to the lack of proper research findings, the question remained unanswered. The present study was planned to observe the virus transmission risk from cadavers to the handlers. A pilot study was conducted on 54 cadavers who died in COVID-ICU (SARS-CoV-2-positive diagnosed by RT-PCR) during 2021–2022. Skin swab sample from 54 dead bodies and 54 glove samples of handlers were taken within 1 hour of death for the RT-PCR test. Viability results from RT-PCR show that the infection risk was 50% in cadavers, whereas the transmission risk to handlers while handling was 7%, which is minimal. The SARS-CoV-2 viability was high in cases of those died after a long time of infection. Based on the RT-PCR result and data analysis the interpretation of the study was that the SARS-CoV-2 transmission risk from dead bodies to the handlers is minimal but the SARS-CoV-2 viability persists in the cadavers. This fact is helpful for the people who will conduct funeral activities, autopsy staff, and hospital staff handling dead bodies.

137

LETTER TO THE EDITOR

Rujittika Mungmunpuntipantip, Viroj Wiwanitkit

ChatGPT in Trauma Triage

[Year:2024] [Month:June] [Volume:28] [Number:6] [Pages:1] [Pages No:617 - 617]

Keywords: AI, ChatGPT, Ethic

   DOI: 10.5005/jp-journals-10071-24545  |  Open Access |  How to cite  | 

140

LETTER TO THE EDITOR

Riddhi Kundu, Tanima Baronia, Prachee Sathe

The Rise of Irrational Antimicrobial Combinations: Need for Clinical Jurisprudence?

[Year:2024] [Month:June] [Volume:28] [Number:6] [Pages:2] [Pages No:618 - 619]

Keywords: Antibiotic sensitivity, Antimicrobial agents, Multidrug resistance

   DOI: 10.5005/jp-journals-10071-24718  |  Open Access |  How to cite  | 

174

LETTER TO THE EDITOR

Ripenmeet Salhotra

Transient Cerebral Circulation Arrest in SAH

[Year:2024] [Month:June] [Volume:28] [Number:6] [Pages:2] [Pages No:620 - 621]

Keywords: Cerebral circulatory arrest, Neurocritical care, Subarachnoid haemorrhage, Transcranial Doppler, Transcranial ultrasound

   DOI: 10.5005/jp-journals-10071-24719  |  Open Access |  How to cite  | 

138

LETTER TO THE EDITOR

Yassine El Bouazizi, Abdelilah Ghannam, Amine Souadka

Shifting Paradigms in Vascular Access: A Deep Dive into the Supraclavicular Approach's Uncharted Waters

[Year:2024] [Month:June] [Volume:28] [Number:6] [Pages:2] [Pages No:622 - 623]

Keywords: Infraclavicular approach, Procedural efficacy and safety, Supraclavicular approach

   DOI: 10.5005/jp-journals-10071-24715  |  Open Access |  How to cite  | 

144

LETTER TO THE EDITOR

Pooja Jaiswal, Priyanka H Chhabra, Suman Saini

Author Response: Shifting Paradigms in Vascular Access: A Deep Dive into the Supraclavicular Approach's Uncharted Waters

[Year:2024] [Month:June] [Volume:28] [Number:6] [Pages:1] [Pages No:624 - 624]

Keywords: Infraclavicular approach, Procedural efficacy and safety, Supraclavicular approach

   DOI: 10.5005/jp-journals-10071-24732  |  Open Access |  How to cite  | 

129

LETTER TO THE EDITOR

Sathwik Gangireddy, Atul Jindal

Beyond the Nasal Prongs: A Joust of Oxygen Delivery Methods in Post-op Hypoxemia

[Year:2024] [Month:June] [Volume:28] [Number:6] [Pages:1] [Pages No:625 - 625]

Keywords: Hypoxemia, Mode of oxygen delivery, Postoperative care

   DOI: 10.5005/jp-journals-10071-24720  |  Open Access |  How to cite  | 

146

LETTER TO THE EDITOR

Susri Mishra, Nikhil Kothari, Ankur Sharma, Shilpa Goyal, Darshana K Rathod, Tanvi Meshram, Pradeep K Bhatia

Author Response: Beyond the Nasal Prongs: A Joust of Oxygen Delivery Methods in Post-op Hypoxemia

[Year:2024] [Month:June] [Volume:28] [Number:6] [Pages:2] [Pages No:626 - 627]

Keywords: Hypoxemia, Oxygenation, P/F ratio

   DOI: 10.5005/jp-journals-10071-24740  |  Open Access |  How to cite  | 

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