International Journal of Critical Illness and Injury Science最新文献

{"title":"Association between baseline insulin resistance and hospital mortality in moderate-to-severe coronavirus disease 2019 patients without diabetes mellitus: An observational study.","authors":"Tazeen Khan, Shilpa Naagar, Parvathy R Nair, Damarla Haritha, Preeti Yadav, Sudip Kumar Datta, Sulagna Bhattacharjee, Yashdeep Gupta, Dalim Kumar Baidya, Rahul Kumar Anand, Bikash Ranjan Ray, Shiba Ansari, Rajeshwari Subramaniam, Souvik Maitra","doi":"10.4103/ijciis.ijciis_41_23","DOIUrl":"10.4103/ijciis.ijciis_41_23","url":null,"abstract":"<p><strong>Background: </strong>Insulin resistance is often implicated as a risk factor of cell-mediated immune dysfunction in sepsis patients and results in poor clinical outcome. However, it is unclear whether early insulin resistance is contributory to T-cell dysfunction and poor clinical outcome in coronavirus disease 2019 (COVID-19) patients.</p><p><strong>Methods: </strong>Adult patients with moderate-to-severe or critically ill COVID-19 infection were included in this study. Serum samples were collected at the time of diagnosis for fasting plasma glucose, serum insulin, serum cortisol, and serum glucagon measurements, and the Homeostatic Model Assessment of Insulin Resistance (HOMA-IR) score was calculated.</p><p><strong>Results: </strong>One hundred and twenty-six subjects with a mean (standard deviation) age of 49.6 (16.3) years were recruited in this study, and 62.4% (78 of 125 patients) were male. HOMA-IR was a predictor of inhospital mortality with the area under the receiver operating characteristics curve (AUROC) (95% confidence interval [CI] of 0.61 [0.49-0.73]). With a cutoff value of 1.91, sensitivity was 75.5% and specificity was 45.2%. Higher serum insulin was associated with higher survival with AUROC (95% CI) of 0.65 (0.53-0.76), and the best cutoff was 7.15, with a sensitivity and specificity of 62.1% and 64.5%. Serum cortisol was also a predictor of inhospital mortality with an AUROC (95% CI) of 0.67 (0.56-0.77).</p><p><strong>Conclusion: </strong>An independent association between baseline serum cortisol and poor outcome in moderate-to-severe COVID-19 patients was observed. Hyperglycemia and HOMA-IR can also predict poor outcome in these patients with some accuracy.</p>","PeriodicalId":13938,"journal":{"name":"International Journal of Critical Illness and Injury Science","volume":"14 1","pages":"26-31"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11073644/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140876393","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predictor of mitral valve regurgitation severity and left ventricular dilatation using amino-terminal pro-brain natriuretic peptide marker in pediatric rheumatic heart disease.","authors":"Dyahris Koentartiwi, Kurniawan Taufiq Kadafi, Fiqi Isnaini Nurul Hikmah, Takhta Khalasha, Ardhanis Ramadhanti, Renny Suwarniaty","doi":"10.4103/ijciis.ijciis_54_23","DOIUrl":"10.4103/ijciis.ijciis_54_23","url":null,"abstract":"<p><strong>Background: </strong>Early rheumatic heart disease (RHD) is characterized by valve regurgitation, leading to ventricular distention and possible elaboration of amino-terminal pro-brain natriuretic peptide (NT-proBNP).</p><p><strong>Methods: </strong>Thirty-one children with RHD were entered in the study. Transthoracic echocardiography was performed in all patients to assess the severity of the valve disease and cardiac function, thus will be classified into three groups: mild, moderate, and severe mitral valve regurgitation (MR), with and without left ventricular (LV) dilatation. At the time of echo, venous blood samples were drawn; thus, NT-proBNP levels were measured using sandwich immunoassay.</p><p><strong>Results: </strong>The median NT-proBNP levels in mild, moderate, and severe MR were 32.34, 120.75, and 7094 pg/ml, respectively. The median NT-proBNP levels in patients with and without LV dilatation were 3045 and 30.82 pg/ml. There was a significant correlation between the severity of MR and NT-proBNP levels (<i>P</i> < 0.001), thus a significant correlation between LV dilatation and NT-proBNP levels (<i>P</i> = 0.013). A cutoff value of 2598.50 pg/ml was obtained with a sensitivity value of 90% and a specificity of 90.5% for NT-proBNP levels against severe MR. A cutoff value of 199.35 pg/ml was obtained with a sensitivity value of 73.3% and a specificity of 75% for NT-proBNP levels on LV dilatation. A cutoff value of 2598.50 pg/ml was obtained with a sensitivity value of 85.7% and a specificity of 79.2% for NT-proBNP levels against severe MR with LV dilatation.</p><p><strong>Conclusion: </strong>There was a significant relationship between NT-proBNP levels and the severity of MR and LV dilatation in children with RHD.</p>","PeriodicalId":13938,"journal":{"name":"International Journal of Critical Illness and Injury Science","volume":"14 1","pages":"43-50"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11073640/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140878401","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tracheostomy timing and outcomes in patients with coronavirus disease 2019-associated acute respiratory distress syndrome: A retrospective observational study.","authors":"Sachin Pralhad Sasane, Madhavi Mahesh Telang, Zeyad Faroor Alrais, Wasim Shabbir Shaikh, Ghaya Zeyad Alrais, Khalid Ismail Khatib","doi":"10.4103/ijciis.ijciis_39_23","DOIUrl":"10.4103/ijciis.ijciis_39_23","url":null,"abstract":"<p><strong>Background: </strong>Patients with coronavirus disease 2019 (COVID-19) pneumonitis may progress to acute respiratory distress syndrome (ARDS) requiring endotracheal intubation and prolonged mechanical ventilation (MV). There are limited data on the optimum time of tracheostomy in COVID-19 patients progressing to ARDS.</p><p><strong>Methods: </strong>This was a retrospective observational study of all patients diagnosed with COVID-19 who progressed to ARDS requiring MV and undergone tracheostomy. We aimed to conduct a study to observe the impact of tracheostomy on the mortality of these patients and the impact of timing of tracheostomy on outcomes in these patients.</p><p><strong>Results: </strong>Of the total 162 patients, 128 (79%) were male and 34 (21%) were female. Early group (≤14 days) comprised 37 patients, while 125 patients were included in late group (>14 days). A total of 91 (56%) patients died at the end of this period. Among the patients who died, 21were included in the early group, while the late group comprised the remaining 70 patients. On comparing the patients who died, the duration of stay in the intensive care unit (ICU) was significantly different in the two groups (median [Q1-Q3]: 12 [11-13] vs. 23 [19-28] days, <i>P</i> < 0.001). The number of days to death also differed significantly between the two groups (median [Q1-Q3]: 28 [21-38] vs. 24 [14-30] days, <i>P</i> = 0.009).</p><p><strong>Conclusion: </strong>Early tracheostomy is associated with significantly shorter length of ICU stay in COVID-19 patients that have progressed to ARDS. However, the timing of tracheostomy had no influence on the overall mortality rate in these patients.</p>","PeriodicalId":13938,"journal":{"name":"International Journal of Critical Illness and Injury Science","volume":"14 1","pages":"15-20"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11073641/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140876399","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"What is new in critical illness and injury science? Patient falls in the intensive care unit.","authors":"Andrew C Miller","doi":"10.4103/ijciis.ijciis_21_24","DOIUrl":"10.4103/ijciis.ijciis_21_24","url":null,"abstract":"","PeriodicalId":13938,"journal":{"name":"International Journal of Critical Illness and Injury Science","volume":"14 1","pages":"1-2"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11073635/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140876400","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Influence of medications on fall risk assessment in maintenance hemodialysis patients: A cross-sectional study.","authors":"Raghad M Ismail, Dixon Thomas, Rajaram Jagdale","doi":"10.4103/ijciis.ijciis_57_23","DOIUrl":"10.4103/ijciis.ijciis_57_23","url":null,"abstract":"<p><strong>Background: </strong>Multiple factors influence the fall risk in end-stage kidney disease. This study aims to investigate how medication factors influence the interpretation of fall risk due to age, gender, and years of dialysis treatment among patients undergoing hemodialysis (HD).</p><p><strong>Methods: </strong>A cross-sectional study was carried out in 2023 using the Johns Hopkins Fall Risk Assessment tool. Participants were recruited from the HD unit at a tertiary care academic medical center in Ajman, UAE. Data were analyzed between different ages, genders, and years on HD categories with or without medication factors.</p><p><strong>Results: </strong>Data were collected and analyzed for 44 patients. The fall risk of the study population assessed with the Kruskal-Wallis test showed no difference between different age groups (<i>P</i> = 0.43) but did show a significant difference when the score of medication factor was removed from the fall risk estimation (<i>P</i> = 0.002). A pairwise analysis showed fall risk score of the age group 46-60 years was differing from the age cohort >60 (<i>P</i> < 0.001). A positive moderate correlation (Spearman's correlation coefficient 0.514 was found, with a <i>P</i> < 0.001) was seen with an increase in age and fall risk only when the medication factor was removed from the fall risk estimation. Results on gender or duration of dialysis were insignificant.</p><p><strong>Conclusion: </strong>Medication factors being a significant contributor to fall risk among the study population was found to mask the fall risk difference between age groups 46-60 years and >60 years. Such influence was not found for gender or duration of dialysis.</p>","PeriodicalId":13938,"journal":{"name":"International Journal of Critical Illness and Injury Science","volume":"14 1","pages":"32-36"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11073637/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140876397","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acute presentation of Wunderlich syndrome in a pregnant woman treated with supra-selective cannulation of renal segmental arteries and nephrectomy: A case report.","authors":"Oscar Orlando Sanabria-Rodríguez, Carlos Fernando Grillo-Ardila, Daniela Mojica-Méndez, Santiago Bottia-Córdoba","doi":"10.4103/ijciis.ijciis_45_23","DOIUrl":"10.4103/ijciis.ijciis_45_23","url":null,"abstract":"<p><p>Wunderlich syndrome is characterized by the presence of abdominal pain, hematuria, and hypovolemic shock. We report a rare case of a 25-year-old pregnant woman, who came to the emergency department due to the sudden onset of low back pain and diaphoresis. The patient, during medical evaluation, experienced an altered state of consciousness. Diagnosed with hypovolemic shock, she was admitted to the operating room, where examination of the abdominal cavity revealed a left retroperitoneal hematoma. Damage control surgery was performed, but given the postoperative clinical deterioration, computerized tomography angiography of the abdomen was performed, showing a mass-like lesion arising from the upper pole of the left kidney, consistent with Wunderlich syndrome. Left nephrectomy was the definitive treatment for the 10-cm renal angiomyolipoma. Since Wunderlich syndrome is a potentially lethal entity, CT is usually the preferred diagnostic approach, and supra-selective vascular embolization is the first-line treatment.</p>","PeriodicalId":13938,"journal":{"name":"International Journal of Critical Illness and Injury Science","volume":"14 1","pages":"62-65"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11073645/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140878400","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A comparative study of perioperative pain, blood loss, and hospital stay in an Indian population undergoing mini-open oblique lumbar interbody fusion versus open transforaminal lumbar interbody fusion.","authors":"Suma Rabab Ahmad, Mantu Jain, Auroshish Sahoo, Narayan Prasad Mishra, Neha Singh, Sumanta Kumar Dansana","doi":"10.4103/ijciis.ijciis_59_23","DOIUrl":"10.4103/ijciis.ijciis_59_23","url":null,"abstract":"<p><strong>Background: </strong>There are several approaches for lumbar fusion, although there is yet to be a consensus on which approach is the best. This study aimed to evaluate the intraoperative blood loss and acute postoperative pain in single-level mini-open oblique lumbar interbody fusion (OLIF) versus open transforaminal lumbar interbody fusion (TLIF) surgeries for the degenerative spine.</p><p><strong>Methods: </strong>Thirty-two patients were assigned by the surgeon to OLIF or TLIF groups - 16 in mini-open OLIF and 16 in open TLIF groups. The intraoperative blood loss and postoperative hemoglobin, numerical rating scale (NRS) at proposed time intervals for 24 h postoperative, and rescue analgesics used were compared among the groups. The operative duration and hospital stay in both groups were also compared.</p><p><strong>Results: </strong>The OLIF group showed significantly higher postoperative hemoglobin (11.5 vs. 10.5 g %, <i>P</i> = 0.04), lower 24-h postoperative pain scores on movement, (NRS 4 vs. 5.5, <i>P</i> = 0.0001), and shorter hospital stay (4.5 vs. 7 days, <i>P</i> = 0.003) than TLIF group. However, the surgery duration was significantly longer in OLIF than in TLIF (190 vs. 150 min, <i>P</i> = 0.005). Intraoperative hemodynamics, other postoperative pain scores at variable time points, and rescue analgesics given were comparable among groups (<i>P</i> > 0.05). Intraoperative blood loss was lower in OLIF than TLIF (275 vs. 500 mL) but was not statistically significant (<i>P</i> > 0.05).</p><p><strong>Conclusion: </strong>Mini-open OLIF has favorable perioperative outcomes compared to open TLIF. Patients have higher postoperative hemoglobin and lesser pain on movement on the first postoperative day, leading to earlier mobilization and a shorter hospital stay.</p>","PeriodicalId":13938,"journal":{"name":"International Journal of Critical Illness and Injury Science","volume":"14 1","pages":"37-42"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11073639/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140876391","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A prospective cohort study evaluating the TRISS and TRISS-SpO₂ scoring systems for assessing mortality risk in trauma study participants in India.","authors":"Rishwanth Vetri, Dhanabalan Piramanayagam, Preethy Ravi","doi":"10.4103/ijciis.ijciis_38_23","DOIUrl":"10.4103/ijciis.ijciis_38_23","url":null,"abstract":"<p><strong>Background: </strong>Globally, trauma cases have significant morbidity and mortality. Hence, various scoring systems have been designed to improve the prognosis in trauma cases. Trauma and Injury Severity Score (TRISS) is one of the widely used models to predict mortality; however, it has certain limitation. We have aimed to evaluate the survival prediction of new model TRISS-oxygen saturation (SpO₂) and to compare with original TRISS score in trauma study participants.</p><p><strong>Methods: </strong>This was a prospective cohort study conducted on 380 trauma study participants admitted to the surgery department from January 20, 2021, to November 28, 2021. The proposed model includes TRISS-SpO₂ which replaces pulse SpO₂ instead of revised trauma score in the original TRISS score. Probability of survival (Ps) was calculated for both models using coefficients derived from Walker-Duncan regression analysis analyzed from the Major Trauma Outcome Study. Receiver operating characteristic curve analysis was used to predict model performance and the accuracy was calculated.</p><p><strong>Results: </strong>The mortality rate in the present study was 30 (7.9%). The predictive accuracy of original TRISS score which calculated Ps based on respiratory rate was 97.11%, and for the proposed model of TRISS score which calculated Ps based on SpO₂ was found 97.11%, and thus there is no significant difference in the performance.</p><p><strong>Conclusions: </strong>The new proposed model TRISS-SpO₂ showed a good accuracy which is similar to original TRISS score. However, the new tool TRISS-SpO₂ might be easier to use for robust performance in the clinical setting.</p>","PeriodicalId":13938,"journal":{"name":"International Journal of Critical Illness and Injury Science","volume":"14 1","pages":"21-25"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11073638/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140876392","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Indoxacarb poisoning presenting as methemoglobinemia: A case report.","authors":"Abdelhakim Osman Hassan Mohammed, Malik Muhammed Akbar Saeed, Akhwand Shakeel Ahmad, Mansoor C Abdulla","doi":"10.4103/ijciis.ijciis_37_23","DOIUrl":"10.4103/ijciis.ijciis_37_23","url":null,"abstract":"<p><p>A 34-year-old Sri Lankan man presented with multiple episodes of vomiting following accidental ingestion of 100 ml of indoxacarb (Avaunt). He had a significant saturation gap (discrepancy between oxygen saturation [98%] in blood gas analysis and saturation on pulse oximetry [70%] in finger pulse oximetry), the color of the blood was muddy brown, and the methemoglobin level (60%) was high in the blood gas analysis. A diagnosis of methemoglobinemia secondary to indoxacarb poisoning was made, and he was treated with methylene blue with a favorable outcome. Methemoglobinemia secondary to indoxacarb poisoning is extremely rare, and clinicians should be aware of this important complication. Methemoglobinemia secondary to indoxacarb poisoning has a favorable outcome if recognized and treated promptly.</p>","PeriodicalId":13938,"journal":{"name":"International Journal of Critical Illness and Injury Science","volume":"14 1","pages":"59-61"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11073642/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140876396","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Metformin toxicity in the intensive care unit: A case series and review of the literature.","authors":"Katherine Nicole Peake, Steven Tessier, Santo Longo, Deborah M Stahlnecker, Osamudiamen Idahosa, Thomas Zanders, Firas Ido","doi":"10.4103/ijciis.ijciis_46_23","DOIUrl":"10.4103/ijciis.ijciis_46_23","url":null,"abstract":"<p><p>Metformin toxicity is a life-threatening condition with high morbidity and mortality. Toxicity predominantly occurs in the setting of acute renal dysfunction, as the drug is solely eliminated by the kidneys. While this risk is widely known to clinicians, diagnosing metformin toxicity is challenging because commercially available serum metformin levels require days to weeks to result. Therefore, the intensivist must rely on medical history, clinical presentation, and routine laboratory findings to make the preliminary diagnosis. Treatment of metformin toxicity includes supportive fluid hydration, vasopressors, and emergent hemodialysis (HD). We report three critically ill patients who had near-fatal severe metformin-induced lactic acidosis. Their metformin levels were markedly higher than the toxicity threshold reported by the Federal Drug Agency. These patients made a prompt and complete recovery after the initiation of HD. We also review the pathophysiology, clinical presentation, diagnosis, and treatment of metformin toxicity.</p>","PeriodicalId":13938,"journal":{"name":"International Journal of Critical Illness and Injury Science","volume":"14 1","pages":"51-58"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11073643/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140876398","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}