Prognosis factors for dengue shock syndrome in children

Background: Varied clinical manifestations, complex pathogenesis, and different viral serotypes make it difficult to predict the course of dengue disease. Many studies have been conducted on the prognostic factors for the occurrence of dengue shock syndrome (SSD), but all use the 2017 World Health Organization (WHO) guidelines. Aim: This study aims to determine the prognostic factors for the occurrence of SSD based on WHO guidelines in 2011. Method: Retrospective study using medical record data of pediatric patients aged 0 to <18 years with a diagnosis of dengue fever dengue (DHF), SSD, and expanded dengue syndrome (EDS) that meet WHO criteria in 2011 at the reputable database from 2017 to December 2020. Independent variables, namely gender, age, nutritional status, secondary dengue infection, leukopenia, abdominal pain, gastrointestinal bleeding, hepatomegaly, and plasma leakage. Shock is the dependent variable. Multivariate analysis using logistic regression analysis. Results: Subjects who met the study criteria were 145 patients, 52 (35.8%) of whom had SSD. Five of 52 SSD patients went into shock during hospitalization. The bivariate analysis yielded significant factors including, malnutrition, overnutrition and obesity, gastrointestinal bleeding, hemoconcentration, ascites, leukocytes 5,000 mm 3, encephalopathy, enzyme elevation heart, and overload. The results of multivariate analysis showed that hemoconcentration variables and elevated liver enzymes were factors of SSD Prognosis. Conclusion: Hemoconcentration and elevated liver enzymes are prognostic factors for SSD.

Case report: Perioperative management of a patient with familial dysautonomia

Familial dysautonomia is a rare autosomal recessive neurodegenerative disease affecting cells of the autonomic nervous system. Patients with this disease are insensitive to pain but their autonomic nervous system is still activated with noxious stimuli. This report details a case of a patient with familial dysautonomia who underwent right ankle open reduction and internal fixation for a bimalleolar right ankle fracture. The patients preoperative and intraoperative course were uneventful but shortly after handoff to the intensive care unit, the patient experienced an autonomic crisis. Management of these patients is complex, requiring maintenance of physiologic homeostasis as well as preventing hemodynamic instability caused by noxious stimuli. Any deviations from baseline may cause an autonomic crisis, as happened in our patient. Herein, we detail the perioperative management of a patient with familial dysautonomia in further detail.

Evaluation of microbial contamination in a surgical department of a Romanian military emergency hospital - A case study

Assessment of the microbial load of the operating environment during daily pre-, intra-, and post-operative procedures in a surgical department of a military emergency hospital in Bucharest showed the bacterial contamination of intra-operative air by increasing the number of bacteria above the allowed maximum level and the detection of a strain of Escherichia coli (E. coli).

Immunocompromised patients with SARS-CoV-2 infection in intensive care units, outcome and mortality

Background: The new severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) outbreak severely hit Northeastern France from March to May 2020. The massive arrival of SARS-CoV-2 positive patients in the intensive care units (ICU) raised the question of how immunocompromised patients would be affected. Therefore, we analyzed the clinical, biological and radiological features of 24 immunocompromised ICU patients with severe SAR-CoV-2 infection. Results: The mortality rate was significantly higher for immunocompromised patients compared with other patients (41.7% versus 27.3%, respectively, p = 0.021). Mortality occurred in the first 2 weeks of intensive care, highlighting the possible interest in prolonged full-code managnement of these patients. Finally, patients with lymphoid malignancies appeared to be particularly affected, mostly with monoclonal gamma-pathology. Conclusion: Mortality rate of SARS-CoV-2 acute respiratory syndrome in immuno-compromised patient is high. No treatment was associated with survival improvement. Prolonged full-code management is required for these patients.

An educational strategy for the implementation of a delirium assessment tool

Background: Delirium is an acute syndrome of organ dysfunction with long-term consequences which commonly occurs in the Intensive Care Unit (ICU). The incidence of delirium ranges from 30% - 50% in low severity ICU patients and up to 80% in mechanically ventilated patients. This condition is frequently under-recognized and daily routine screening is a key strategy to early intervention. The Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) and the Intensive Care Delirium Screening Checklist (ICDSC) are the most recommended assessment tools for detecting delirium in the critical ill patient. Objective: The main objective of this study is to educate ICU staff about delirium. In addition, nurses were trained to use the CAM-ICU as a standard screening tool. The intervention was evaluated through a survey aimed at ICU staff. Methods: An educational intervention was started in 2014 in our ICU. An educational package for ICU staff consisted of a didactic brochure and explanatory videos. One-on-one teaching, case based scenarios and didactic teaching were strategies used in the implementation process. The entire intervention was evaluated by means of a survey directed to the professionals. Results: The structure of the didactic brochure was simple in order to have an easy understanding of the CAM-ICU tool. We also created 10-minute videos. According to the results of the satisfaction survey (N=62), disorganized thinking was the most difficult feature of CAM-ICU to interpret. When in doubt, consultation between co-workers was the primary resource selected by unit staff. Conclusion: This initiative achieved the objective of training health care professionals in the application of the CAM-ICU tool with a good level of satisfaction from them. Therefore, ICU staff consider delirium management in the broader picture of critically ill patient care as a major activity of daily practice.

The continued relevance of Deep Brain Stimulation for chronic pain

For the millions of patients experiencing chronic pain despite pharmacotherapy, deep brain stimulation (DBS) provides a beacon of hope. Over the past decade the field has shifted away from DBS towards other forms of neuromodulation, particularly spinal cord stimulation (SCS). DBS for pain is still performed, albeit off-label in US and UK, and experiences variable success rates. SCS is an extremely useful tool for the modulation of pain but is limited in its application to specific pain aetiologies. We advocate use of DBS for pain, for patients for whom pharmacology has failed and for whom spinal cord stimulation is inadequate. DBS for chronic pain is at risk of premature neglect. Here we outline how this has come to pass, and in the process argue for the untapped potential for this procedure.

Transoral laser resection of a large schwannoma in the retropharyngeal space

Introduction: The contents of the retropharyngeal space are limited to fat and retropharyngeal nodes. Primary tumors originating from the retropharyngeal space are rare, therefore, the existence of schwannoma in the retropharyngeal space is infrequent. Method: This paper describes a case of a large schwannoma of the retropharyngeal space excised transorally with the use of co2 laser. This lesion measured about 6/6 x 3/5. Result: No peri-or post-operative complications were encountered. The procedure allowed quick resumption of an oral diet and a return to normal activity for the patient. Conclusion: This is, to our knowledge, the first report of this technique used in the excision of a large retropharyngeal space schwannoma.