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tafi SM, Ganapathy U, Kumar A, et al. Physiological Effects of N95 FFP and PPE in Healthcare Workers in COVID Intensive Care Unit A Prospective Cohort Study. Indian J Crit Care Med 2020;24(12)1169-1173."Change of gene frequency in population" is the most fundamental concept of evolutionary biology. Human sepsis is a quantitative biological war between microbial genes and human genes, fought through their respective phenotypes. The prize of this war is an increase of gene frequency. Stating that sepsis is caused by a dysregulated host response is missing one half of the septic syndrome. Clinicians may gain a different perspective into the many intricacies of sepsis by conceptualizing it as an adaptive evolutionary process, rather than an abnormal physiological state. Clinicians may also get a deeper perspective by seeing it as a genotypic evolutionary process of natural selection rather than a phenotypic pathophysiological event. How to cite this article Kapadia FN. Sepsis An Evolutionary Perspective (Sepsis through the Eyes of a Microbe vs Clinical Sepsis through the Eyes of an Intensivist). Indian J Crit Care Med 2020;24(12)1165-1168.How to cite this article Udani V. Posterior Reversible Encephalopathy Syndrome An Expanding Phenotype. Indian J Crit Care Med 2020;24(12)1163-1164.Efforts are continuing worldwide to understand the epidemiology, pathogenesis, and treatments for coronavirus disease-2019 (COVID-19). However, at the moment treatment remains supportive with oxygen therapy, steroids, repurposed antivirals, and prevention of multiple organ dysfunction by using immunomodulators. COVID-19 remains challenging since the disease spectrum varies from asymptomatic infection to severe acute respiratory distress syndrome (ARDS) with high fatality rates. It is thus necessary to predict clinical outcomes and risk-stratify patients for ensuring early intensive care unit (ICU) admissions. An important aspect is building surge capacity, managing and optimizing therapeutic and operational resources. So far, data have been scarce, particularly from India, to identify predictors of poor outcomes and mortality early in the course of the disease. Risk models need to be developed in larger patient cohorts and the models need to be simple and easy to employ at the onset of the disease process to predict the risk of severe disease, need for mechanical ventilation, ICU length of stay (LOS), and mortality. How to cite this article Bhosale SJ, Kulkarni AP. Crystal Gazing Myth or Reality for Critical Care for COVID-19 Patients? Indian J Crit Care Med 2020;24(12)1161-1162.How to cite this article Singh L. Role of Prophylactic Noninvasive Ventilation in Patients at High Risk of Extubation Failure. Indian J Crit Care Med 2020;24(12)1158-1160.How to cite this article Jha SK. Physiological Effects of N95 FFP and Personal Protective Equipment in Healthcare Workers in COVID ICU A Prospective Cohort Study. Indian J Crit Care Med 2020;24(12)1156-1157.How to cite this article Venkataraman R. Thromboelastogram to Detect Hypercoagulability in Critically Ill COVID-19 Patients Has Its Time Come? Indian J Crit Care Med 2020;24(12)1154-1155.Adrenomedullin (ADM) is a 52 amino acid containing free circulating vasoactive peptide hormone found to be active in various pathophysiological states including sepsis. Histone Methyltransferase inhibitor High ADM levels at admission have been correlated with vasopressor requirements, organ dysfunction, and mortality in sepsis patients. ADM stimulation results in vasodilation and loss of vascular resistance in humans resulting in hypotension with the potential for negative impact in septic shock. However, in vitro human and animal experiments have shown that ADM decreases hyperpermeability and capillary leak, thus having an endothelial barrier stabilizing effect during septic shock. Adrenomedullin thus appears to be a double-edged weapon. This editorial critically reviews the article by Daga et al. who evaluated serum ADM as a prognostic marker to review the gender-related difference in mortality pattern, and also the correlation of ADM level to APACHE II and SOFA scores. The role of adrenomedullin in sepsis and the potential developments in the future have been discussed concisely. How to cite this article Ajith Kumar AK. Adrenomedullin in Sepsis Finally, a Friend or an Enemy? Indian J Crit Care Med 2020;24(12)1151-1153.Multiplexed analysis allows simultaneous measurements of multiple targets, improving the detection sensitivity and accuracy. However, highly multiplexed analysis has been challenging for point-of-care (POC) sensing, which requires a simple, portable, robust, and affordable detection system. In this work, we developed paper-based POC sensing arrays consisting of kaleidoscopic fluorescent compounds. Using an indolizine structure as a fluorescent core skeleton, named Kaleidolizine (KIz), a library of 75 different fluorescent KIz derivatives were designed and synthesized. These KIz derivatives are simultaneously excited by a single ultraviolet (UV) light source and emit diverse fluorescence colors and intensities. For multiplexed POC sensing system, fluorescent compounds array on cellulose paper was prepared and the pattern of fluorescence changes of KIz on array were specific to target chemicals adsorbed on that paper. Furthermore, we developed a machine-learning algorithm for automated, rapid analysis of color and intensity changes of individual sensing arrays. We showed that the paper sensor arrays could differentiate 35 different volatile organic compounds using a smartphone-based handheld detection system. Powered by the custom-developed machine-learning algorithm, we achieved the detection accuracy of 97% in the VOC detection. The highly multiplexed paper sensor could have favorable applications for monitoring a broad-range of environmental toxins, heavy metals, explosives, pathogens.Among the types of acute thyroiditis, subacute thyroiditis (SAT) is rare in children, and there is limited knowledge regarding its characteristics in pediatric cases. We present a case of SAT in a 6-yr-old boy who was brought to our hospital with high fever and pain in the front portion of the neck. Acute suppurative thyroiditis (AST), which is common in children, was suspected initially. Tenderness observed in the thyroid corresponded to a hypoechoic region on ultrasonography. The tenderness subsequently shifted to the isthmus, which was evident as a hypoechoic region on ultrasonography. Movement of hypoechoicity is typical of creeping thyroiditis, wherein the pain and tenderness can be unilateral or may start on one side and subsequently shift to the contralateral side after days or even weeks. Based on this characteristic and changes in laboratory parameters, the patient was diagnosed as a case of creeping thyroiditis. Improvement was observed in the patient without the use of anti-inflammatory drugs. At the 2-yr follow-up, the patient did not have thyrotoxicosis or relapse.
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