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Publisher: Medknow Publishers   (Total: 355 journals)

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Showing 1 - 200 of 354 Journals sorted alphabetically
Advanced Arab Academy of Audio-Vestibulogy J.     Open Access  
Advances in Human Biology     Open Access   (Followers: 1)
African J. for Infertility and Assisted Conception     Open Access  
African J. of Business Ethics     Open Access   (Followers: 6)
African J. of Medical and Health Sciences     Open Access   (Followers: 2)
African J. of Paediatric Surgery     Open Access   (Followers: 7, SJR: 0.269, h-index: 10)
African J. of Trauma     Open Access  
Ain-Shams J. of Anaesthesiology     Open Access   (Followers: 3)
Al-Azhar Assiut Medical J.     Open Access  
Al-Basar Intl. J. of Ophthalmology     Open Access   (Followers: 1)
Ancient Science of Life     Open Access   (Followers: 6)
Anesthesia : Essays and Researches     Open Access   (Followers: 8)
Annals of African Medicine     Open Access   (Followers: 1, SJR: 0.331, h-index: 15)
Annals of Bioanthropology     Open Access   (Followers: 3)
Annals of Cardiac Anaesthesia     Open Access   (Followers: 14, SJR: 0.408, h-index: 15)
Annals of Indian Academy of Neurology     Open Access   (Followers: 3, SJR: 0.308, h-index: 14)
Annals of Maxillofacial Surgery     Open Access   (Followers: 6)
Annals of Medical and Health Sciences Research     Open Access   (Followers: 7)
Annals of Nigerian Medicine     Open Access   (Followers: 1)
Annals of Pediatric Cardiology     Open Access   (Followers: 7, SJR: 0.441, h-index: 10)
Annals of Saudi Medicine     Open Access   (SJR: 0.24, h-index: 29)
Annals of Thoracic Medicine     Open Access   (Followers: 4, SJR: 0.388, h-index: 19)
Annals of Tropical Medicine and Public Health     Open Access   (Followers: 15, SJR: 0.148, h-index: 5)
APOS Trends in Orthodontics     Open Access   (Followers: 1)
Arab J. of Interventional Radiology     Open Access  
Archives of Intl. Surgery     Open Access   (Followers: 9)
Archives of Medicine and Health Sciences     Open Access   (Followers: 3)
Archives of Pharmacy Practice     Open Access   (Followers: 6)
Asia Pacific J. of Clinical Trials : Nervous System Diseases     Open Access  
Asia-Pacific J. of Oncology Nursing     Open Access   (Followers: 3)
Asian J. of Andrology     Open Access   (Followers: 1, SJR: 0.879, h-index: 49)
Asian J. of Neurosurgery     Open Access   (Followers: 2)
Asian J. of Oncology     Open Access   (Followers: 1)
Asian J. of Transfusion Science     Open Access   (Followers: 2, SJR: 0.362, h-index: 10)
Astrocyte     Open Access  
Avicenna J. of Medicine     Open Access   (Followers: 1)
AYU : An international quarterly journal of research in Ayurveda     Open Access   (Followers: 6)
Benha Medical J.     Open Access  
BLDE University J. of Health Sciences     Open Access  
Brain Circulation     Open Access  
Bulletin of Faculty of Physical Therapy     Open Access   (Followers: 1)
Cancer Translational Medicine     Open Access   (Followers: 1)
CHRISMED J. of Health and Research     Open Access  
Clinical Dermatology Review     Open Access   (Followers: 1)
Clinical Trials in Degenerative Diseases     Open Access  
Clinical Trials in Orthopedic Disorders     Open Access   (Followers: 1)
Community Acquired Infection     Open Access  
Conservation and Society     Open Access   (Followers: 12, SJR: 0.82, h-index: 12)
Contemporary Clinical Dentistry     Open Access   (Followers: 4)
Current Medical Issues     Open Access   (Followers: 1)
CytoJ.     Open Access   (Followers: 2, SJR: 0.339, h-index: 19)
Delta J. of Ophthalmology     Open Access  
Dental Hypotheses     Open Access   (Followers: 3, SJR: 0.131, h-index: 4)
Dental Research J.     Open Access   (Followers: 9)
Dentistry and Medical Research     Open Access  
Digital Medicine     Open Access  
Drug Development and Therapeutics     Open Access  
Education for Health     Open Access   (Followers: 5, SJR: 0.205, h-index: 22)
Egyptian J. of Bronchology     Open Access  
Egyptian J. of Cardiothoracic Anesthesia     Open Access  
Egyptian J. of Cataract and Refractive Surgery     Open Access   (Followers: 1)
Egyptian J. of Dermatology and Venerology     Open Access   (Followers: 1)
Egyptian J. of Haematology     Open Access  
Egyptian J. of Internal Medicine     Open Access   (Followers: 1)
Egyptian J. of Neurology, Psychiatry and Neurosurgery     Open Access   (Followers: 1, SJR: 0.121, h-index: 3)
Egyptian J. of Obesity, Diabetes and Endocrinology     Open Access  
Egyptian J. of Otolaryngology     Open Access   (Followers: 2)
Egyptian J. of Psychiatry     Open Access   (Followers: 2)
Egyptian J. of Surgery     Open Access   (Followers: 1)
Egyptian Orthopaedic J.     Open Access  
Egyptian Pharmaceutical J.     Open Access  
Egyptian Retina J.     Open Access  
Egyptian Rheumatology and Rehabilitation     Open Access  
Endodontology     Open Access  
Endoscopic Ultrasound     Open Access   (SJR: 0.473, h-index: 8)
Environmental Disease     Open Access   (Followers: 2)
European J. of Dentistry     Open Access   (Followers: 2, SJR: 0.496, h-index: 11)
European J. of General Dentistry     Open Access   (Followers: 1)
European J. of Prosthodontics     Open Access   (Followers: 2)
European J. of Psychology and Educational Studies     Open Access   (Followers: 8)
Fertility Science and Research     Open Access  
Formosan J. of Surgery     Open Access   (SJR: 0.107, h-index: 5)
Genome Integrity     Open Access   (Followers: 4, SJR: 1.227, h-index: 12)
Global J. of Transfusion Medicine     Open Access   (Followers: 2)
Heart India     Open Access   (Followers: 1)
Heart Views     Open Access   (Followers: 2)
Hepatitis B Annual     Open Access   (Followers: 3)
IJS Short Reports     Open Access  
Indian Anaesthetists Forum     Open Access  
Indian Dermatology Online J.     Open Access   (Followers: 3)
Indian J. of Allergy, Asthma and Immunology     Open Access   (Followers: 1)
Indian J. of Anaesthesia     Open Access   (Followers: 8, SJR: 0.302, h-index: 13)
Indian J. of Burns     Open Access   (Followers: 1)
Indian J. of Cancer     Open Access   (SJR: 0.318, h-index: 26)
Indian J. of Cerebral Palsy     Open Access   (Followers: 1)
Indian J. of Community Medicine     Open Access   (Followers: 2, SJR: 0.618, h-index: 16)
Indian J. of Critical Care Medicine     Open Access   (Followers: 2, SJR: 0.307, h-index: 16)
Indian J. of Dental Research     Open Access   (Followers: 4, SJR: 0.243, h-index: 24)
Indian J. of Dental Sciences     Open Access  
Indian J. of Dentistry     Open Access   (Followers: 1)
Indian J. of Dermatology     Open Access   (Followers: 2, SJR: 0.448, h-index: 16)
Indian J. of Dermatology, Venereology and Leprology     Open Access   (Followers: 3, SJR: 0.563, h-index: 29)
Indian J. of Dermatopathology and Diagnostic Dermatology     Open Access  
Indian J. of Drugs in Dermatology     Open Access   (Followers: 1)
Indian J. of Endocrinology and Metabolism     Open Access   (Followers: 4)
Indian J. of Health Sciences     Open Access   (Followers: 2)
Indian J. of Medical and Paediatric Oncology     Open Access   (SJR: 0.292, h-index: 9)
Indian J. of Medical Microbiology     Open Access   (Followers: 1, SJR: 0.53, h-index: 34)
Indian J. of Medical Research     Open Access   (Followers: 4, SJR: 0.716, h-index: 60)
Indian J. of Medical Sciences     Open Access   (Followers: 2, SJR: 0.207, h-index: 31)
Indian J. of Multidisciplinary Dentistry     Open Access   (Followers: 1)
Indian J. of Nephrology     Open Access   (Followers: 2, SJR: 0.233, h-index: 12)
Indian J. of Nuclear Medicine     Open Access   (Followers: 2, SJR: 0.213, h-index: 5)
Indian J. of Occupational and Environmental Medicine     Open Access   (Followers: 4, SJR: 0.203, h-index: 13)
Indian J. of Ophthalmology     Open Access   (Followers: 5, SJR: 0.536, h-index: 34)
Indian J. of Oral Health and Research     Open Access  
Indian J. of Oral Sciences     Open Access   (Followers: 1)
Indian J. of Orthopaedics     Open Access   (Followers: 9, SJR: 0.393, h-index: 15)
Indian J. of Otology     Open Access   (Followers: 1, SJR: 0.218, h-index: 5)
Indian J. of Paediatric Dermatology     Open Access   (Followers: 2)
Indian J. of Pain     Open Access   (Followers: 1)
Indian J. of Palliative Care     Open Access   (Followers: 5, SJR: 0.35, h-index: 12)
Indian J. of Pathology and Microbiology     Open Access   (Followers: 1, SJR: 0.285, h-index: 22)
Indian J. of Pharmacology     Open Access   (SJR: 0.347, h-index: 44)
Indian J. of Plastic Surgery     Open Access   (Followers: 12, SJR: 0.303, h-index: 13)
Indian J. of Psychiatry     Open Access   (Followers: 3, SJR: 0.496, h-index: 15)
Indian J. of Psychological Medicine     Open Access   (Followers: 1, SJR: 0.344, h-index: 9)
Indian J. of Public Health     Open Access   (Followers: 1, SJR: 0.444, h-index: 17)
Indian J. of Radiology and Imaging     Open Access   (Followers: 4, SJR: 0.253, h-index: 14)
Indian J. of Research in Homoeopathy     Open Access  
Indian J. of Rheumatology     Open Access   (SJR: 0.169, h-index: 7)
Indian J. of Sexually Transmitted Diseases and AIDS     Open Access   (Followers: 2, SJR: 0.313, h-index: 9)
Indian J. of Social Psychiatry     Open Access   (Followers: 2)
Indian J. of Urology     Open Access   (Followers: 3, SJR: 0.366, h-index: 16)
Indian J. of Vascular and Endovascular Surgery     Open Access   (Followers: 2)
Industrial Psychiatry J.     Open Access   (Followers: 2)
Intl. J. of Academic Medicine     Open Access  
Intl. J. of Advanced Medical and Health Research     Open Access  
Intl. J. of Applied and Basic Medical Research     Open Access  
Intl. J. of Clinical and Experimental Physiology     Open Access   (Followers: 1)
Intl. J. of Critical Illness and Injury Science     Open Access   (Followers: 1)
Intl. J. of Educational and Psychological Researches     Open Access   (Followers: 4)
Intl. J. of Environmental Health Engineering     Open Access   (Followers: 1)
Intl. J. of Forensic Odontology     Open Access   (Followers: 1)
Intl. J. of Green Pharmacy     Open Access   (Followers: 4, SJR: 0.229, h-index: 13)
Intl. J. of Health & Allied Sciences     Open Access   (Followers: 3)
Intl. J. of Health System and Disaster Management     Open Access   (Followers: 3)
Intl. J. of Heart Rhythm     Open Access  
Intl. J. of Medicine and Public Health     Open Access   (Followers: 7)
Intl. J. of Mycobacteriology     Open Access   (SJR: 0.239, h-index: 4)
Intl. J. of Noncommunicable Diseases     Open Access  
Intl. J. of Nutrition, Pharmacology, Neurological Diseases     Open Access   (Followers: 4)
Intl. J. of Oral Health Sciences     Open Access   (Followers: 1)
Intl. J. of Orthodontic Rehabilitation     Open Access  
Intl. J. of Pedodontic Rehabilitation     Open Access  
Intl. J. of Pharmaceutical Investigation     Open Access   (Followers: 1)
Intl. J. of Preventive Medicine     Open Access   (Followers: 1, SJR: 0.523, h-index: 15)
Intl. J. of Shoulder Surgery     Open Access   (Followers: 7, SJR: 0.611, h-index: 9)
Intl. J. of Trichology     Open Access   (SJR: 0.37, h-index: 10)
Intl. J. of Yoga     Open Access   (Followers: 15)
Intl. J. of Yoga : Philosophy, Psychology and Parapsychology     Open Access   (Followers: 6)
Iranian J. of Nursing and Midwifery Research     Open Access   (Followers: 3)
Iraqi J. of Hematology     Open Access  
J. of Academy of Medical Sciences     Open Access  
J. of Advanced Pharmaceutical Technology & Research     Open Access   (Followers: 4, SJR: 0.427, h-index: 15)
J. of Anaesthesiology Clinical Pharmacology     Open Access   (Followers: 8, SJR: 0.416, h-index: 14)
J. of Applied Hematology     Open Access  
J. of Association of Chest Physicians     Open Access   (Followers: 2)
J. of Basic and Clinical Reproductive Sciences     Open Access   (Followers: 1)
J. of Cancer Research and Therapeutics     Open Access   (Followers: 4, SJR: 0.359, h-index: 21)
J. of Carcinogenesis     Open Access   (Followers: 1, SJR: 1.152, h-index: 26)
J. of Cardiothoracic Trauma     Open Access  
J. of Cardiovascular Disease Research     Open Access   (Followers: 3, SJR: 0.351, h-index: 13)
J. of Cardiovascular Echography     Open Access   (SJR: 0.134, h-index: 2)
J. of Cleft Lip Palate and Craniofacial Anomalies     Open Access   (Followers: 2)
J. of Clinical and Preventive Cardiology     Open Access   (Followers: 1)
J. of Clinical Imaging Science     Open Access   (Followers: 1, SJR: 0.277, h-index: 8)
J. of Clinical Neonatology     Open Access   (Followers: 1)
J. of Clinical Ophthalmology and Research     Open Access   (Followers: 2)
J. of Clinical Sciences     Open Access  
J. of Conservative Dentistry     Open Access   (Followers: 4, SJR: 0.532, h-index: 10)
J. of Craniovertebral Junction and Spine     Open Access   (Followers: 4, SJR: 0.199, h-index: 9)
J. of Current Medical Research and Practice     Open Access  
J. of Current Research in Scientific Medicine     Open Access  
J. of Cutaneous and Aesthetic Surgery     Open Access   (Followers: 1)
J. of Cytology     Open Access   (Followers: 1, SJR: 0.274, h-index: 9)
J. of Dental and Allied Sciences     Open Access   (Followers: 1)
J. of Dental Implants     Open Access   (Followers: 7)
J. of Dental Lasers     Open Access   (Followers: 2)
J. of Dental Research and Review     Open Access   (Followers: 1)
J. of Digestive Endoscopy     Open Access   (Followers: 3)
J. of Dr. NTR University of Health Sciences     Open Access  
J. of Earth, Environment and Health Sciences     Open Access   (Followers: 1)
J. of Education and Ethics in Dentistry     Open Access   (Followers: 5)
J. of Education and Health Promotion     Open Access   (Followers: 5)
J. of Emergencies, Trauma and Shock     Open Access   (Followers: 9, SJR: 0.353, h-index: 14)
J. of Engineering and Technology     Open Access   (Followers: 6)
J. of Experimental and Clinical Anatomy     Open Access   (Followers: 2)
J. of Family and Community Medicine     Open Access   (Followers: 2)
J. of Family Medicine and Primary Care     Open Access   (Followers: 11)

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Journal Cover Indian Journal of Critical Care Medicine
  [SJR: 0.307]   [H-I: 16]   [2 followers]  Follow
    
  This is an Open Access Journal Open Access journal
   ISSN (Print) 0972-5229
   Published by Medknow Publishers Homepage  [355 journals]
  • A clinical study on the initial assessment of arterial lactate and base
           deficit as predictors of outcome in trauma patients

    • Authors: Rameshbabu Homanna Javali, Prithvishree Ravindra, Akkamahadevi Patil, Madhu Srinivasarangan, Harshit Mundada, SB Adarsh, S Nisarg
      Pages: 719 - 725
      Abstract: Rameshbabu Homanna Javali, Prithvishree Ravindra, Akkamahadevi Patil, Madhu Srinivasarangan, Harshit Mundada, SB Adarsh, S Nisarg
      Indian Journal of Critical Care Medicine 2017 21(11):719-725
      Background: Trauma is a leading cause of mortality in India. Outcomes can be improved by early recognition of hemorrhagic shock and expedited management. At present, we rely on traditional vital signs, which are not sensitive measures. Point of care biochemical markers have been emerging as prognostic markers in trauma, but have not been studied in Indian setting. Aims: This study aims to study the association between arterial lactate and base deficit (BD) at emergency department (ED) admission and 24 h outcome in trauma patients at risk of hemodynamic compromise. Materials and Methods: This was a prospective observational study on 100 trauma patients at risk of hemodynamic compromise in tertiary care center ED. Arterial blood gas analysis at admission and 24 h outcomes were noted and statistically analyzed. Results: Arterial lactate ≥4 mmol/L (sensitivity 100% and specificity 85.9%), BD ≥12 mEq/L (sensitivity 87.5% and specificity 82.6%) had more sensitivity than vital signs for predicting 24 h mortality. Higher lactate and BD were associated with increased blood transfusion requirement. Best cutoff values for predicting transfusion were lactate ≥2.9 mmol/L (sensitivity 65.2% and specificity 90.7%), BD ≥8 mEq/L (sensitivity 78.3% and specificity 75.9%). BD-based classification was comparable to ATLS classification in predicting mortality and determining transfusion requirements. Patients with higher arterial lactate and BD were found to have higher 24 h Intensive Care Unit (ICU) admission. Conclusion: Emergency admission arterial lactate and Base Deficit are useful predictors of mortality, need for blood transfusion and ICU admission at 24 h. It can be used to triage, identify shock early, assess transfusion requirement, and prognosticate trauma patients.
      Citation: Indian Journal of Critical Care Medicine 2017 21(11):719-725
      PubDate: Mon,13 Nov 2017
      DOI: 10.4103/ijccm.IJCCM_218_17
      Issue No: Vol. 21, No. 11 (2017)
       
  • The PCQP score for volume status of acutely ill patients: Integrating
           vascular pedicle width, caval index, respiratory variability of the qrs
           complex and R wave amplitude

    • Authors: Ali Taghizadieh, Kavous Shahsavari Nia, Payman Moharramzadeh, Mahboob Pouraghaei, Atefeh Ghavidel, Zahra Parsian, Ata Mahmoodpoor
      Pages: 726 - 732
      Abstract: Ali Taghizadieh, Kavous Shahsavari Nia, Payman Moharramzadeh, Mahboob Pouraghaei, Atefeh Ghavidel, Zahra Parsian, Ata Mahmoodpoor
      Indian Journal of Critical Care Medicine 2017 21(11):726-732
      Introduction: Techniques for measuring volume status of critically ill patients include invasive, less invasive, or noninvasive ones. The present study aims to assess the accuracy of noninvasive techniques for measuring volume status of critically ill patients. Patients and Methods: A total of 111 critically ill patients admitted to the emergency department and undergoing central venous catheterization were included in the study. Five parameters were measured including vascular pedicle width (VPW), diameter of inferior vena cava, caval index, respiratory changes in QRS, and P wave amplitude. Patients with risk factors which could decrease the accuracy of central venous pressure (CVP) value were excluded from study. We compared these parameters with static CVP parameter. Finally, based on the afore-mentioned parameters, PCQP role in criteria was designed. Results: In detecting loss of circulating blood volume, area under the curve of VPW was 0.92 (90%, confidence interval [CI]: 0.85–0.99), diameter of inferior vena cava was 0.82 (90%, CI: 0.72–0.91), caval index was 0.9 (90%, CI: 0.82–0.98), and changes in QRS and P waves were 0.88 (95%, CI: 0.81–0.95) and 0.73 (95%, CI: 0.63–0.82), respectively. PCQP role in criteria was designed according to these parameters, and at its best cutoff point (score 6), VPW had a sensitivity of 97.4% (95%, CI: 84.57–99.99) and specificity of 83.6% (95%, CI: 72.65–90.86) for the detection of loss of circulating blood volume (<8 cmH2O). Conclusion: PCQP score could be a reliable and noninvasive technique for the assessment of volume status in critically ill patients.
      Citation: Indian Journal of Critical Care Medicine 2017 21(11):726-732
      PubDate: Mon,13 Nov 2017
      DOI: 10.4103/ijccm.IJCCM_275_17
      Issue No: Vol. 21, No. 11 (2017)
       
  • Critical care junior doctors' profile in a lower middle-income
           country: A national cross-sectional survey

    • Authors: Ambepitiyawaduge Pubudu De Silva, D. D. S. Baranage, Anuruddha Padeniya, Ponsuge Chathurani Sigera, Sunil De Alwis, Anuja Unnathie Abayadeera, Palitha G Mahipala, Kosala Saroj Jayasinghe, Arjen M Dondorp, Rashan Haniffa
      Pages: 733 - 739
      Abstract: Ambepitiyawaduge Pubudu De Silva, D. D. S. Baranage, Anuruddha Padeniya, Ponsuge Chathurani Sigera, Sunil De Alwis, Anuja Unnathie Abayadeera, Palitha G Mahipala, Kosala Saroj Jayasinghe, Arjen M Dondorp, Rashan Haniffa
      Indian Journal of Critical Care Medicine 2017 21(11):733-739
      Background and Aims: Retention of junior doctors in specialties such as critical care is difficult, especially in resource-limited settings. This study describes the profile of junior doctors in adult state intensive care units in Sri Lanka, a lower middle-income country. Materials and Methods: This was a national cross-sectional survey using an anonymous self-administered electronic questionnaire. Results: Five hundred and thirty-nine doctors in 93 Intensive Care Units (ICUs) were contacted, generating 207 responses. Just under half of the respondents (93, 47%) work exclusively in ICUs. Most junior doctors (150, 75.8%) had no previous exposure to anesthesia and 134 (67.7%) had no previous ICU experience while 116 (60.7%) ICU doctors wished to specialize in critical care. However, only a few (12, 6.3%) doctors had completed a critical care diploma course. There was a statistically significant difference (P < 0.05) between the self-assessed confidence of anesthetic background junior doctors and non-anesthetists. The overall median competency for doctors improves with the length of ICU experience and is statistically significant (P < 0.05). ICU postings were less happy and more stressful compared to the last non-ICU posting (P < 0.05 for both). The vast majority, i.e., 173 (88.2%) of doctors felt the care provided for patients in their ICUs was good, very good, or excellent while 71 doctors (36.2%) would be happy to recommend the ICU where they work to a relative with the highest possible score of 10. Conclusion: Measures to improve training opportunities for these doctors and strategies to improve their retention in ICUs need to be addressed.
      Citation: Indian Journal of Critical Care Medicine 2017 21(11):733-739
      PubDate: Mon,13 Nov 2017
      DOI: 10.4103/ijccm.IJCCM_268_17
      Issue No: Vol. 21, No. 11 (2017)
       
  • Role of urinary neutrophil gelatinase-associated lipocalin as a biomarker
           of acute kidney injury in patients with circulatory shock

    • Authors: Radhey Shyam, Munna Lal Patel, Rekha Sachan, Satish Kumar, Durgesh Kumar Pushkar
      Pages: 740 - 745
      Abstract: Radhey Shyam, Munna Lal Patel, Rekha Sachan, Satish Kumar, Durgesh Kumar Pushkar
      Indian Journal of Critical Care Medicine 2017 21(11):740-745
      Background: The early prediction of acute kidney injury (AKI) by the current clinical and laboratory methods remains inadequate. Neutrophil gelatinase-associated lipocalin (NGAL) has emerged as a promising noninvasive biomarker of kidney injury in shock. The aim of this study was to assess the ability of urinary NGAL (uNGAL) to predict AKI in adult Intensive Care Unit (ICU) patients. Materials and Methods: We prospectively studied 70 patients with circulatory shock admitted to the ICU over a period of 1 year. uNGAL was analyzed at ICU admission and after 24 h. Risk, injury, failure, loss, and end-stage kidney criteria were calculated at admission and for consecutive 4 days. The primary outcome was AKI defined as an increase in creatinine of at least 50% from baseline or a reduction in urine output to <0.5 ml/kg/h for 6 h. Results: uNGAL was a good diagnostic marker for AKI development; at day 1, the cutoff value 48.54 ng/mL had a sensitivity and specificity of 79.49 and 73.14, respectively, and the area under the curve (AUC) of 0.82 (95% confidence interval [CI], 0.75–0.87) for predicting AKI. At day 2, the cutoff value 190.92 ng/mL had a sensitivity and specificity of 90.0 and 64.66, respectively, and the AUC of 0.76 (95% CI, 0.70–0.88) for predicting AKI. Conclusion: uNGAL could be a good early predictor biomarker of AKI following circulatory shock.
      Citation: Indian Journal of Critical Care Medicine 2017 21(11):740-745
      PubDate: Mon,13 Nov 2017
      DOI: 10.4103/ijccm.IJCCM_315_17
      Issue No: Vol. 21, No. 11 (2017)
       
  • Reliability and validity of the checklist for early recognition and
           treatment of acute illness and injury as a charting tool in the medical
           intensive care unit

    • Authors: Alexander Kogan, Kelly M Pennington, Saraschandra Vallabhajosyula, Mikhail Dziadzko, Courtney E Bennett, Jeffrey B Jensen, Ognjen Gajic, John C O&#39;Horo
      Pages: 746 - 750
      Abstract: Alexander Kogan, Kelly M Pennington, Saraschandra Vallabhajosyula, Mikhail Dziadzko, Courtney E Bennett, Jeffrey B Jensen, Ognjen Gajic, John C O'Horo
      Indian Journal of Critical Care Medicine 2017 21(11):746-750
      Background: Resuscitation of critically ill patients is complex and potentially prone to diagnostic errors and therapeutic harm. The Checklist for early recognition and treatment of acute illness and injury (CERTAIN) is an electronic tool that aims to provide decision-support, charting, and prompting for standardization. This study sought to evaluate the validity and reliability of CERTAIN in a real-time Intensive Care Unit (ICU). Materials and Methods: This was a prospective pilot study in the medical ICU of a tertiary care medical center. A total of thirty patient encounters over 2 months period were charted independently by two CERTAIN investigators. The inter-observer recordings and comparison to the electronic medical records (EMR) were used to evaluate reliability and validity, respectively. The primary outcome was reliability and validity measured using Cohen's Kappa statistic. Secondary outcomes included time to completion, user satisfaction, and learning curve. Results: A total of 30 patients with a median age of 59 (42–78) years and median acute physiology and chronic health evaluation III score of 38 (23–50) were included in this study. Inter-observer agreement was very good (κ = 0.79) in this study and agreement between CERTAIN and the EMR was good (κ = 0.5). CERTAIN charting was completed in real-time that was 121 (92–150) min before completion of EMR charting. The subjective learning curve was 3.5 patients without differences in providers with different levels of training. Conclusions: CERTAIN provides a reliable and valid method to evaluate resuscitation events in real time. CERTAIN provided the ability to complete data in real-time.
      Citation: Indian Journal of Critical Care Medicine 2017 21(11):746-750
      PubDate: Mon,13 Nov 2017
      DOI: 10.4103/ijccm.IJCCM_209_17
      Issue No: Vol. 21, No. 11 (2017)
       
  • Treatment of acute kidney injury complicating septic shock with EMiC2
           high-cutoff hemofilter: Case series

    • Authors: Hoi-Ping Shum, King-Chung Chan, Wing-Wa Yan, Tak Mao Chan
      Pages: 751 - 757
      Abstract: Hoi-Ping Shum, King-Chung Chan, Wing-Wa Yan, Tak Mao Chan
      Indian Journal of Critical Care Medicine 2017 21(11):751-757
      Introduction: Extracorporeal blood purification therapies have been proposed to improve outcomes of patients with severe sepsis, with or without accompanying acute kidney injury (AKI), by removal of excessive inflammatory mediators. Materials and Methods: We report our experience with EMiC2 high-cutoff continuous venovenous hemofiltration/hemodialysis (HCO-CVVH/HD) in seven patients with AKI complicating septic shock. Results: The median treatment duration was 71 h, and the procedure was well tolerated. Trough serum albumin level of 20 g/L was observed after 2 h of treatment and none of the patients required albumin supplement. The hospital mortality rate was 29%, which appeared more favorable than the predicted mortality of 60%–78% based on disease severity scores. Circulating levels of interleukin-6 (IL-6), IL-10, and tumor necrosis factor-alpha improved over time. Conclusion: This case series shows that HCO-CVVH/CVVHD using EMiC2 hemofilter may provide good cytokine modulation, when used along with good quality standard sepsis therapy. A further large-scale prospective randomized controlled trial is recommended.
      Citation: Indian Journal of Critical Care Medicine 2017 21(11):751-757
      PubDate: Mon,13 Nov 2017
      DOI: 10.4103/ijccm.IJCCM_338_17
      Issue No: Vol. 21, No. 11 (2017)
       
  • An interventional quality improvement study to assess the compliance to
           cardiopulmonary resuscitation documentation in an indian teaching hospital
           

    • Authors: Viraj Nevrekar, Prasan Kumar Panda, Naveet Wig, RM Pandey, Praveen Agarwal, Ashutosh Biswas
      Pages: 758 - 764
      Abstract: Viraj Nevrekar, Prasan Kumar Panda, Naveet Wig, RM Pandey, Praveen Agarwal, Ashutosh Biswas
      Indian Journal of Critical Care Medicine 2017 21(11):758-764
      Background: Cardiopulmonary resuscitation (CPR) should be performed as per the international guidelines; however, compliance to these guidelines is difficult to assess. This study was conducted to determine the compliance to American Heart Association (2010) guideline on CPR documentation by among resident physicians before and after resident training (two arms). Methods: This pre–postinterventional quality improvement study was conducted in a referral center, North India. Data of hospitalized in-hospital CPR patients were collected in the form of quality indicators (checklists) as defined by the guideline and compared between two arms of before–after resident training. Residents were given appropriate training in CPR technique as per the guideline. The compliance of CPR documentation was assessed pre- and post-intervention. Results: The baseline arm compliance of various components of CPR documentation was low. The postintervention arm compliances of all components significantly increased (baseline, 2.5% to postintervention, 15.11%, P = 0.03). Individual components assessed were documentation of assessment of responsiveness (65% to 77.9%, P = 0.19), assessment of breathing (37.5% to 58.1%, P = 0.03), assessment of carotid pulse (62.5% to 79%, P = 0.05), rate of chest compressions (20% to 39.5%, P = 0.04), airway management (62.5% to 82.5%, P = 0.02), and compressions to breaths ratio (12.5% to 31.4%, P = 0.02). Documentation of chest compression rate compared to nondocumentation (12 of 42 vs. 11 of 84, P = 0.04) was independently associated with a higher rate of return of spontaneous circulation. The study however did not show any survival benefits. Conclusions: This study establishes that the compliance to CPR documentation is poor as assessed by CPR documentation content and quality, which improves after physician training, but not up to the mark level (100%) that may be due to busy Indian hospital settings and human behavioral factors. Due to ethical constraints of live CPR assessment, this document checklist approach may be considered as an internal quality assessment method for CPR compliance. Furthermore, correct instruction in CPR technique along with proper documentation of the procedure is required, followed up with periodic re-education during the residency period and beyond.
      Citation: Indian Journal of Critical Care Medicine 2017 21(11):758-764
      PubDate: Mon,13 Nov 2017
      DOI: 10.4103/ijccm.IJCCM_249_17
      Issue No: Vol. 21, No. 11 (2017)
       
  • Prophylaxis and incidence of symptomatic deep vein thrombosis in indian
           patients with sepsis: DETECT-deep vein thrombosis registry

    • Authors: Nagarajan Ramakrishnan, DETECT-DVT Investigators
      Pages: 765 - 771
      Abstract: Nagarajan Ramakrishnan, DETECT-DVT Investigators
      Indian Journal of Critical Care Medicine 2017 21(11):765-771
      Purpose: To assess thromboprophylaxis rate and incidence of symptomatic deep vein thrombosis (DVT) in Indian patients with acute sepsis. Materials and Methods: Adult patients with sepsis, within 48 h of sepsis onset/hospital admission were included. DVT was assessed using Doppler ultrasonography if clinical signs were present. Data were collected at inclusion, discharge, and 30 ± 7 days (if discharged before 30 days). Results: The study included 278 patients (men: 69.4%; mean age: 56.3 ± 17.99 years). Out of 275 patients (data missing for 3 patients), 188 (68.4%; 95% confidence interval: 62.5–73.8) received DVT prophylaxis (185 at admission and 3 at discharge; pharmacological prophylaxis: n = 88, mechanical prophylaxis: n = 65, pharmacological + mechanical prophylaxis: n = 35) and 87 received no prophylaxis. In line with American College of Chest Physicians 2008 recommendations, among patients who received pharmacological prophylaxis (n = 123), low-molecular-weight heparin was given to 85.4% (n = 105) patients (duration: 9.1 ± 6.36 days), unfractionated heparin to 12.2% (n = 15) patients (duration: 9.2 ± 9.18 days), and fondaparinux to 5.7% (n = 7) patients (duration: 6.8 ± 3.30 days); 27/63 patients at high-risk of bleeding received mechanical prophylaxis; no patient received aspirin. Of 9 patients who developed DVT, 7 received no thromboprophylaxis (data missing for 2 patients). In total, 186/274 (67.9%) patients recovered from sepsis. Conclusions: Two-third patients received thromboprophylaxis. The substantial role of thromboprophylaxis in DVT prevention mandates monitoring and control of thromboprophylaxis through internal audits in hospitals.
      Citation: Indian Journal of Critical Care Medicine 2017 21(11):765-771
      PubDate: Mon,13 Nov 2017
      DOI: 10.4103/ijccm.IJCCM_205_17
      Issue No: Vol. 21, No. 11 (2017)
       
  • Posterior reversible leukoencephalopathy syndrome (PRES) in intensive care
           unit – Case series

    • Authors: Antara Gokhale, Atheel Kimona, Sandeep Kantor, S Prakash, Yogesh Manhas
      Pages: 772 - 778
      Abstract: Antara Gokhale, Atheel Kimona, Sandeep Kantor, S Prakash, Yogesh Manhas
      Indian Journal of Critical Care Medicine 2017 21(11):772-778
      Introduction: Posterior reversible encephalopathy syndrome (PRES) is characterized by a range of clinico neuro radiological manifestation along with hypertension due to varied etiology. Contrary to its name, a small number of patients have residual neurological deficits. Patients with severe manifestation of PRES may get admitted to the Intensive Care Unit (ICU) due to coma or status epilepticus. Small case series and large multicenter studies have been reported. Materials and Methods: We report a single center series of ten cases admitted to ICU over a 5 year period in a tertiary care centre. We retrospectively analyzed patients, admitted to adult ICU with different etiologies, and diagnosed to have PRES. Outcome at discharge and at 90 days after ICU admission was noted. Result: The most common etiologies were medications. ICU admissions were mainly for uncontrolled hypertension, seizures, and low level of consciousness. All except one patient were ventilated. Four patients had residual neurological damage. Conclusion: Irrespective of the etiology, early control of blood pressure, and removal of precipitating factors is of paramount importance to prevent morbidity and mortality. Awareness about PRES among the intensivist is necessary to ensure early recognition and treatment.
      Citation: Indian Journal of Critical Care Medicine 2017 21(11):772-778
      PubDate: Mon,13 Nov 2017
      DOI: 10.4103/ijccm.IJCCM_235_17
      Issue No: Vol. 21, No. 11 (2017)
       
  • Effect of intensive education and training of nurses on
           ventilator-associated pneumonia and central line-associated bloodstream
           infection incidence in intensive care unit at a tertiary care center in
           North India

    • Authors: Neeru Sahni, Manisha Biswal, Komal Gandhi, Kulbeer Kaur, Vikas Saini, Lakshminarayana N Yaddanapudi
      Pages: 779 - 782
      Abstract: Neeru Sahni, Manisha Biswal, Komal Gandhi, Kulbeer Kaur, Vikas Saini, Lakshminarayana N Yaddanapudi
      Indian Journal of Critical Care Medicine 2017 21(11):779-782
      Objective: The aim was to analyze the impact of education and training of nurses on the incidence of ventilator-associated pneumonia (VAP) and central line-associated bloodstream infection (CLABSI). Patients and Methods: A prospective observational study at a tertiary care hospital included adult patients with Intensive Care Unit stay >48 h. The study was done in three phases: in Phase 1, baseline VAP and CLABSI incidence was calculated; in Phase 2, education and training of nurses; and in Phase 3, data were recollected for the incidence of VAP and CLABSI. Results: The baseline incidence of VAP in Phase 1 was 28.86/1000 ventilator days and that of CLABSI was 7.89/1000 central-line days. In Phase 3, the incidence of VAP increased to 35.06 and that of CLABSI decreased significantly, 1.73. Conclusion: Intensive education and training sessions with feedback from nurses over a period of 6 months led to significant reduction in the incidence of CLABSI; however, the incidence of VAP increased.
      Citation: Indian Journal of Critical Care Medicine 2017 21(11):779-782
      PubDate: Mon,13 Nov 2017
      DOI: 10.4103/ijccm.IJCCM_259_17
      Issue No: Vol. 21, No. 11 (2017)
       
  • Cerebral air embolism secondary to lung laceration

    • Authors: Ashok Kumar Singh, Jayant Verma, Surendra Kumar
      Pages: 783 - 785
      Abstract: Ashok Kumar Singh, Jayant Verma, Surendra Kumar
      Indian Journal of Critical Care Medicine 2017 21(11):783-785
      Cerebral air embolism is a rare clinical entity in day-to-day practice. The introduction of air into the venous or the arterial system can cause cerebral air embolism leading to severe neurological deficits. The common causes reported in the literature are iatrogenic; it can be caused by positive pressure maneuvers performed during cardiac resuscitation, lung biopsy, and the placement of venous catheters in the presence of a patent foramen ovale. We report a case of cerebral air embolism which has occurred secondary to lung laceration. The patient underwent intercostal drainage for hydro-pneumothorax and developed forceful cough and suddenly changed in consciousness. Air embolism was diagnosed by computed tomography brain and was managed by high-concentration oxygen therapy and other supportive measures and is being discharged in satisfactory condition.
      Citation: Indian Journal of Critical Care Medicine 2017 21(11):783-785
      PubDate: Mon,13 Nov 2017
      DOI: 10.4103/ijccm.IJCCM_291_17
      Issue No: Vol. 21, No. 11 (2017)
       
  • Imidacloprid poisoning: An emerging cause of potentially fatal poisoning

    • Authors: Sanjay A Mundhe, Siddheshwar V Birajdar, Sheshrao S Chavan, Nikhil R Pawar
      Pages: 786 - 788
      Abstract: Sanjay A Mundhe, Siddheshwar V Birajdar, Sheshrao S Chavan, Nikhil R Pawar
      Indian Journal of Critical Care Medicine 2017 21(11):786-788
      There are a variety of pesticides that are used to control the pests in agricultural lands and other places. Newer pesticides, developed as an alternative to highly toxic organophosphates such as imidacloprid including other neonicotinoid compounds, are being increasingly used considering their less harmful effects in case of human exposures. Though it is considered relatively safer to human beings, it can lead to potentially life-threatening complications and acute poisoning with these compounds may be fatal in large ingestion. We report a case of poisoning with imidacloprid compound presenting with a variety of systemic features including respiratory failure and patient's improvement with conservative management.
      Citation: Indian Journal of Critical Care Medicine 2017 21(11):786-788
      PubDate: Mon,13 Nov 2017
      DOI: 10.4103/ijccm.IJCCM_152_17
      Issue No: Vol. 21, No. 11 (2017)
       
  • Meckel&#39;s diverticulitis masquerading as acute pancreatitis: A
           diagnostic dilemma

    • Authors: C Danny Darlington, G Fatima Shirly Anitha
      Pages: 789 - 792
      Abstract: C Danny Darlington, G Fatima Shirly Anitha
      Indian Journal of Critical Care Medicine 2017 21(11):789-792
      Meckel's diverticulum is a remnant of the proximal part of the vitellointestinal duct and is the most common congenital anomaly of the gastrointestinal tract. It may either remain asymptomatic or present with myriad of clinical presentations. Gastrointestinal bleeding is the most common presentation in children whereas it is intestinal obstruction in the case of adults. We report a 9-year-old boy who presented with acute onset of periumbilical pain and nonbilious vomiting. His clinical and laboratory parameters were unremarkable, except for serum amylase levels. He was conservatively managed initially as acute pancreatitis with paralytic ileus. However, the child deteriorated in a course of 2 days with bilious vomiting, abdominal distension, and dehydration. Imaging was suggestive of an ileoileal intussusception, and exploratory laparotomy identified Meckel's diverticulum as the lead point for the intussusception. The histopathological examination revealed inflamed heterotopic pancreatic tissue at the apex of the diverticulum thus explaining the elevated amylase levels. This case is reported to highlight the atypical presentation of Meckel's diverticulum and the high clinical suspicion warranted in diagnosing such concomitant intussusception.
      Citation: Indian Journal of Critical Care Medicine 2017 21(11):789-792
      PubDate: Mon,13 Nov 2017
      DOI: 10.4103/ijccm.IJCCM_317_17
      Issue No: Vol. 21, No. 11 (2017)
       
  • Canagliflozin-associated diabetic ketoacidosis with lower-than-anticipated
           glucose levels

    • Authors: Sonali Vadi, Manjusha Agarwal
      Pages: 793 - 795
      Abstract: Sonali Vadi, Manjusha Agarwal
      Indian Journal of Critical Care Medicine 2017 21(11):793-795
      The Food and Drug Administration has approved the use of sodium-glucose co-transporter 2 (SGLT-2) inhibitors for use in Type II diabetics. These are a relatively new addition to the armamentaria of diabetes management. Postmarketing surveillance is a witness to several side effects, a morbid one being ketoacidosis. Herein is discussed a scenario of a Type II diabetic who presented with substantial ketoacidosis without significant hyperglycemia. The absence of the customary precipitating factors and the presence of a recent introduction of canagliflozin, a SGLT-2 inhibitor to the diabetes prescription, hinted at the causal relationship. Of note, she had never experienced diabetic ketoacidosis in the past prior to commencement of SGLT-2 inhibitor therapy. As clinicians, we need to be aware of the treatment-emergent adverse effect of this relatively new class of diabetic treatment.
      Citation: Indian Journal of Critical Care Medicine 2017 21(11):793-795
      PubDate: Mon,13 Nov 2017
      DOI: 10.4103/ijccm.IJCCM_328_17
      Issue No: Vol. 21, No. 11 (2017)
       
  • Methadone gastrobezoar in a psychiatric patient presented in coma

    • Authors: Alexandra Gavala, Despoina Manou, Vasiliki Psalida, Maria Nystatzaki, Christos Mavrogiannis, George Alevizopoulos, Pavlos Myrianthefs
      Pages: 796 - 798
      Abstract: Alexandra Gavala, Despoina Manou, Vasiliki Psalida, Maria Nystatzaki, Christos Mavrogiannis, George Alevizopoulos, Pavlos Myrianthefs
      Indian Journal of Critical Care Medicine 2017 21(11):796-798
      A 43-year-old psychiatric patient was transferred in coma and hypercapnic respiratory failure at the emergency department. He was intubated for airway protection and transferred to the Intensive Care Unit (ICU). Abdominal X-ray revealed a radiopaque mass; a pharmacobezoar was suspected and confirmed by gastroscopy; one large in the stomach fundus and a smaller one in the pylorus. Gastric lavage through the gastroscope and administration of gastro-kinetic drugs and laxatives were able to dilute the bezoars. Tablets retrieved from the stomach identified as methadone and toxicological tests of the gastric fluid confirmed the presence of methadone as the only organic chemical compound. The patient was extubated on the 7th day and released from the ICU on the 10th day under psychiatric consultation having normal vital signs. Methadone gastric bezoar may lead to persistent intoxication, respiratory failure, and coma requiring ICU care. Diagnosis may be difficult and a high index of suspicion is needed.
      Citation: Indian Journal of Critical Care Medicine 2017 21(11):796-798
      PubDate: Mon,13 Nov 2017
      DOI: 10.4103/ijccm.IJCCM_17_17
      Issue No: Vol. 21, No. 11 (2017)
       
  • Malpositioning of central venous catheter from right to left subclavian
           vein: A rare complication

    • Authors: P Rajendra Takhar, Bunkar Motilal, Arya Savita
      Pages: 799 - 801
      Abstract: P Rajendra Takhar, Bunkar Motilal, Arya Savita
      Indian Journal of Critical Care Medicine 2017 21(11):799-801
      Invasive monitoring with central venous catheter (CVC) is a valuable tool now a day in Intensive Care Units and in postoperative hemodynamically unstable patients. It is often employed for administering medications and parenteral nutrition. In most of the instances, these catheters are inserted using proper topographical landmarks and ultrasonography-guided methods. Central venous cannulation is associated now and then with unexpected complications despite the use of all precautions and help of imaging techniques. There is a wide variety of complications related to the central venous cannulation including malpositioning. Malpositioning of the catheter into contralateral subclavian is an extremely unusual event. Here, we report a rare case of malpositioning of CVC from the right to the left subclavian vein also we outline how the misplacement was identified and effectively managed.
      Citation: Indian Journal of Critical Care Medicine 2017 21(11):799-801
      PubDate: Mon,13 Nov 2017
      DOI: 10.4103/0972-5229.218155
      Issue No: Vol. 21, No. 11 (2017)
       
  • Influenza B virus triggering macrophage activation syndrome in an infant

    • Authors: K Jayashree, Suchetha Rao, Nutan Kamath
      Pages: 802 - 803
      Abstract: K Jayashree, Suchetha Rao, Nutan Kamath
      Indian Journal of Critical Care Medicine 2017 21(11):802-803
      Macrophage activation syndrome (MAS) is a potentially fatal complication caused by excessive activation and expansion of macrophages and T lymphocytes. It can be triggered by various infections and is characterized by the development of cytopenias, hyperferritinemia, liver dysfunction, and coagulopathy. We report a 10-month-old female infant with fever, convulsions, and hepatosplenomegaly. Laboratory data of bicytopenia, low erythrocyte sedimentation rate, and elevated liver enzymes suggested MAS. This was supported by the presence of hyperferritinemia with hypertriglyceridemia. MAS was triggered by influenza B virus. She responded to treatment with immunoglobulin and steroid.
      Citation: Indian Journal of Critical Care Medicine 2017 21(11):802-803
      PubDate: Mon,13 Nov 2017
      DOI: 10.4103/0972-5229.218137
      Issue No: Vol. 21, No. 11 (2017)
       
  • Accidental ingestion of traces of cyanide: A clinical experience

    • Authors: Sadananda B Naik
      Pages: 804 - 805
      Abstract: Sadananda B Naik
      Indian Journal of Critical Care Medicine 2017 21(11):804-805

      Citation: Indian Journal of Critical Care Medicine 2017 21(11):804-805
      PubDate: Mon,13 Nov 2017
      DOI: 10.4103/ijccm.IJCCM_288_17
      Issue No: Vol. 21, No. 11 (2017)
       
  • Integrative weaning index: A few observations

    • Authors: Animesh Ray
      Pages: 805 - 806
      Abstract: Animesh Ray
      Indian Journal of Critical Care Medicine 2017 21(11):805-806

      Citation: Indian Journal of Critical Care Medicine 2017 21(11):805-806
      PubDate: Mon,13 Nov 2017
      DOI: 10.4103/0972-5229.218154
      Issue No: Vol. 21, No. 11 (2017)
       
 
 
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