Notes

[Sevestre-Jacquet posterosive syphilitic eczema associated with the using recycleable diapers: The clinical case].
Multiple Peaked Cytokine Storm Is Multiple Exposures to the COVID-19 Virus a Possible Cause? Indian J Crit Care Med 2021;25(4)463-464.
Kumar A, Kumar A, Kumar A, Kumar N, Sinha C, Singh V. Multiple Peaked Cytokine Storm Is Multiple Exposures to the COVID-19 Virus a Possible Cause? Indian J Crit Care Med 2021;25(4)463-464.Coronavirus disease-2019 (COVID-19) disease is often complicated by venous thrombosis and embolism. However, arterial thrombosis in a patient already on therapeutic anticoagulation is a rare occurrence. In one patient, we found thrombosis of the radial artery leading to ischemia of the fingers and lateral part of the palm. TPEN concentration In another patient, thrombosis was found in the anterior tibial artery, resulting in ischemia of the limb and amputation. Both these patients were on a therapeutic dose of low-molecular-weight heparin. In both cases, heparin infusion was started but with little benefit. It is suggested that intensified anticoagulation should be done in patients at high-risk venous thrombosis, and prompt interventional thrombectomy should be done in cases of failure of pharmacological anticoagulation.
Kumar A, Kumar N, Arun SK, Ghosh S, Pattanayak A. Acute Peripheral Arterial Thrombosis in COVID-19 Patients on Therapeutic Anticoagulation. Indian J Crit Care Med 2021;25(4)461-462.
Kumar A, Kumar N, Arun SK, Ghosh S, Pattanayak A. Acute Peripheral Arterial Thrombosis in COVID-19 Patients on Therapeutic Anticoagulation. Indian J Crit Care Med 2021;25(4)461-462.Among the various strategies for the prevention of airborne transmission, engineering measures are placed high in the hierarchy of control. Modern hospitals in high-income countries have mechanical systems of building ventilation also called HVAC (heating, ventilation, and air-conditioning) but installation and maintenance of such systems is a challenging and resource-intensive task. Even when the state-of-the-art technology was used to build airborne infection isolation rooms (AIIRs), recommended standards were often not met in field studies. The current coronavirus disease-2019 pandemic has highlighted the need to find cost-effective and less resource-intensive engineering solutions. Moreover, there is a need for the involvement of interdisciplinary teams to find innovative infection control solutions and doctors are frequently lacking in their understanding of building ventilation-related problems as well as their possible solutions. The current article describes building ventilation strategies (natural ventilation and hybrid ventilation) for hospitals where HVAC systems are either lacking or do not meet the recommended standards. Other measures like the use of portable air cleaning technologies and temporary negative-pressure rooms can be used as supplementary strategies in situations of demand surge. It can be easily understood that thermal comfort is compromised in buildings that are not mechanically fitted with HVAC systems, therefore the given building ventilation strategies are more helpful when climatic conditions are moderate or other measures are combined to maintain thermal comfort.
Zia H, Singh R, Seth M, Ahmed A, Azim A. Engineering Solutions for Preventing Airborne Transmission in Hospitals with Resource Limitation and Demand Surge. Indian J Crit Care Med 2021;25(4)453-460.
Zia H, Singh R, Seth M, Ahmed A, Azim A. Engineering Solutions for Preventing Airborne Transmission in Hospitals with Resource Limitation and Demand Surge. Indian J Crit Care Med 2021;25(4)453-460.
Given the current lack of an approved and effective treatment or vaccine for severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), repositioning old drugs for use as an antiviral treatment is an interesting strategy because knowledge about these drugs' safety profile, posology, and drug interactions is already known. Chloroquine and hydroxychloroquine, widely used as antimalarial and autoimmune disease drugs, have recently been reported as a potential broad-spectrum antiviral drug.

The
antiviral activity of chloroquine has been identified since the late 1960s. However, antiviral mechanisms of chloroquine remain speculative. Several clinical trials have been conducted to test the efficacy and safety of chloroquine or hydroxychloroquine in the treatment of COVID-19-associated pneumonia. The quality of the studies and the outcomes are evaluated in this systematic review and meta-analysis.

Literature review revealed 23 clinical studies. Only 9 of 23 studies were randomized controlled trials. Of nRM, Namachivayam A. Evidence for Chloroquine/Hydroxychloroquine in the Treatment of COVID-19. Indian J Crit Care Med 2021;25(4)441-452.
Shetty RM, Namachivayam A. Evidence for Chloroquine/Hydroxychloroquine in the Treatment of COVID-19. Indian J Crit Care Med 2021;25(4)441-452.
With the advancement of pediatric critical care services across India, many children require prolonged mechanical ventilation (MV), and tracheostomy is recommended to them. However, many pediatric intensivists have concerns regarding the safety, feasibility, and outcome of tracheostomy.We aimed to analyze clinical characteristics, indication, duration, and outcome of tracheostomized children with respect to timing of tracheostomy.

We conducted a retrospective study from the hospital clinical database of consecutive patients below 12 years who had undergone tracheostomy after admission into the pediatric intensive care unit (PICU) for prolonged ventilation (≥96 hours) from January 2015 to December 2019. The study was approved by the Institutional Ethics Committee. Patients were divided into two groups tracheostomies done within 14 days of MV (early tracheostomy) and patients with tracheostomies performed after 14 days (late tracheostomy). Patients' age, sex, indications, complications, decannulation rate, MV.

In the context of scarcity of data on the timing of tracheostomy in children with prolonged ventilation (≥96 hours) the study shows that early (<14 days) tracheostomy is associated with a better outcome.

Sarkar M, Roychowdhoury S, Bhakta S, Raut S, Nandi M. Tracheostomy before 14 Days Is It Associated with Better Outcomes in Pediatric Patients on Prolonged Mechanical Ventilation? Indian J Crit Care Med 2021;25(4)435-440.
Sarkar M, Roychowdhoury S, Bhakta S, Raut S, Nandi M. Tracheostomy before 14 Days Is It Associated with Better Outcomes in Pediatric Patients on Prolonged Mechanical Ventilation? Indian J Crit Care Med 2021;25(4)435-440.
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