Notes

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Manjunath V, Nadaf S, Chakor RT. Delayed Post-hypoxic Leukoencephalopathy with Neuroradiological Recovery. Indian J Crit Care Med 2021;25(11)1326-1328.Kumar A, Kumar A, Kumar A, Sinha C, Kumar N, Singh PK. Acute Exacerbation of Cough as a Precipitating Cause of Hypoxia in COVID-19 Patients. Indian J Crit Care Med 2021;25(11)1324-1325.Trikha A, Venkateswaran V, Soni KD. Extracorporeal Membrane Oxygenation in COVID-19 Patients More Hype than Substance? Indian J Crit Care Med 2021;25(11)1322-1323.Pradhan S, Kumar N, Kumar S. Severe COVID-19 along with Cytokine Storm in Pemphigus Vulgaris Managed Successfully with Dexamethasone Pulse Therapy. Indian J Crit Care Med 2021;25(11)1320-1321.Coronavirus disease-2019 (COVID-19)-associated mucormycosis is on the rise in the Indian subcontinent. We report a unique case of cutaneous mucormycosis in a case of newly diagnosed young diabetic patient with severe COVID-19 pneumonia with post-COVID lung fibrosis. Neither did he have any preceding trauma or wound, nor was there any evidence of any secondary dissemination. Cutaneous mucormycosis without evidence of either is unheard off. Possible risk factors in this case were multiple bacterial secondary infections with the use of higher antibiotics, use of voriconazole for possible aspergillosis, and steroid use.
Tambe RR, Hinduja A, Sunil S, Varaiya A, Joshi A. Cutaneous Mucormycosis in a Patient of Severe COVID-19 Pneumonia A Rarer than Rare Case Report. Indian J Crit Care Med 2021;25(11)1318-1319.
Tambe RR, Hinduja A, Sunil S, Varaiya A, Joshi A. Cutaneous Mucormycosis in a Patient of Severe COVID-19 Pneumonia A Rarer than Rare Case Report. Indian J Crit Care Med 2021;25(11)1318-1319.Infectious diseases with the coronavirus disease-2019 (COVID-19) can be linked to various microbial and fungal coinfections. Mucormycosis is an invasive opportunistic infection that enters as inhalation of fungal spores through the nose or paranasal sinuses in diabetic and immunocompromised patients. We present our experience of managing seven cases of recent COVID-19 infection with uncontrolled diabetes who developed rhino-orbital mucormycosis. All patients were diagnosed by clinical examination and imaging and managed by emergency surgical debridement and liposomal amphotericin-B. A lethal triad of impaired immunity due to COVID-19 infection, state of hyperglycemia, increased use of steroids, or rampant broad-spectrum antimicrobials works as fertile soil and may assist in the growth or alleviation of a fungal infection. Healthcare professionals must be aware of the potential of secondary invasive fungal infections in diabetic patients with moderate to severe category of COVID-19 infectious disease, especially on steroid therapy.
Panwar P, Gupta A, Kumar A, Gupta B, Navriya SC. Mucormycosis in COVID Diabetic Patients A Horrifying Triad! Indian J Crit Care Med 2021;25(11)1314-1317.
Panwar P, Gupta A, Kumar A, Gupta B, Navriya SC. Mucormycosis in COVID Diabetic Patients A Horrifying Triad! Indian J Crit Care Med 2021;25(11)1314-1317.
Healthcare-associated infections (HAIs) can impact the outcome following traumatic brain injury (TBI) in children. We undertook a retrospective observational study to see the incidence, risk factors, and microbiological profile for HAIs in pediatric TBI. We also studied the impact of baseline patient characteristics, HAIs on patient outcome, and antibiotic resistance of different types of bacteria.

Data on pediatric TBI patients of age up to 12 years were collected via a computerized patient record system (CPRS) from January 2012 to December 2018. Descriptive Chi-square test and Wilcoxon signed rank test were used to characterize baseline parameters. General linear regression models were run to find an unadjusted and adjusted odds ratio (OR).

HAIs were found in 144 (34%) out of 423 patients. The most commonly seen infections were of the respiratory tract in 73 (17.26%) subjects. The most predominant microorganism isolated was
in 188 (41%) samples.
.
was sensitive to colistin in 91 (48.4%) patients. Male gender (OR 0.630;
-value 0.035), fall from height (OR 0.374;
-value 0.008), and higher injury severity scale (ISS) (OR 1.040;
-value 0.002) were independent risk factors for development of HAIs. Severe TBI, higher ISS and Marshall grade, and HAIs were significantly associated with poor patient outcome.

Severe TBI poses a significant risk of HAIs. The most common site was the respiratory tract, predominately infected with
. HAIs in pediatric TBI patients resulted in poor patient outcome.

Prasad C, Bindra A, Singh P, Singh GP, Singh PK, Mathur P. Healthcare-associated Infections in Pediatric Patients in Neurotrauma Intensive Care Unit A Retrospective Analysis. Indian J Crit Care Med 2021;25(11)1308-1313.
Prasad C, Bindra A, Singh P, Singh GP, Singh PK, Mathur P. Healthcare-associated Infections in Pediatric Patients in Neurotrauma Intensive Care Unit A Retrospective Analysis. Indian J Crit Care Med 2021;25(11)1308-1313.
The objective of the study was to describe the clinico-virological profile, treatment details, intensive care needs, and outcome of infants with acute viral bronchiolitis (AVB).

In this prospective observational study, 173 infants with AVB admitted to the pediatric emergency room and pediatric intensive care unit (PICU) of a tertiary care teaching hospital in North India during November 2019 to February 2020 were enrolled. The data collection included clinical features, viruses detected [respiratory syncytial virus (RSV), rhinovirus, influenza A virus, parainfluenza virus (PIV) 2 and 3, and human metapneumovirus (hMPV)], complications, intensive care needs, treatment, and outcomes. Multivariate analysis was performed to determine independent predictors for PICU admission.

Most common symptoms were rapid breathing (98.8%), cough (98.3%), and fever (74%). On examination, tachypnea (98.8%), chest retractions (93.6%), respiratory failure (84.4%), wheezing (49.7%), and crepitations (23.1%) were observed. RSVadmission. The presence of comorbidity, chest retractions, respiratory failure, shock, and need for mechanical ventilation independently predicted PICU admission.

Angurana SK, Takia L, Sarkar S, Jangra I, Bora I, Ratho RK,
. Clinico-virological Profile, Intensive Care Needs, and Outcome of Infants with Acute Viral Bronchiolitis A Prospective Observational Study. Indian J Crit Care Med 2021;25(11)1301-1307.
Angurana SK, Takia L, Sarkar S, Jangra I, Bora I, Ratho RK, et al. Clinico-virological Profile, Intensive Care Needs, and Outcome of Infants with Acute Viral Bronchiolitis A Prospective Observational Study. Indian J Crit Care Med 2021;25(11)1301-1307.In the absence of a definitive therapy during this ongoing unprecedented crisis, coronavirus disease-2019 (COVID-19) pandemic, convalescent plasma transfusion (CPT) has shown some promising results. read more This review summarizes the existing evidence of the efficacy of CPT in COVID-19 patients based upon scientific publications to date. We have included only the randomized controlled trials (RCTs) through an extensive screening of electronic databases up to July 31, 2021. In 19 RCTs, with a total of 16,476 COVID-19 patients we found low-quality evidence of significant reduction in mortality (odds ratio (OR) = 0.80; 95% confidence interval (CI) 0.66-0.96, I2 = 40%), better clinical outcome when applied
Sarkar S, Khanna P, Singh AK. Convalescent -Plasma-A Light at the End of the Tunnel A Systematic Review and Meta-analysis of Randomized Controlled Trials. Indian J Crit Care Med 2021;25(11)1292-1300.
Sarkar S, Khanna P, Singh AK. Convalescent -Plasma-A Light at the End of the Tunnel A Systematic Review and Meta-analysis of Randomized Controlled Trials. Indian J Crit Care Med 2021;25(11)1292-1300.COVID-19 has become a major pandemic in recent times. The exact pathophysiology and understanding of cytokine storm and immunomodulation are evolving. Various cytokines have been implicated in the pathophysiology of COVID-19. Immunosuppressant immunomodulators like steroids, canakinumab, anakinra, tocilizumab, sarilumab, baricitinib, ruxolitinib, bevacizumab, and itolizumab have been tried. Immunostimulant immunomodulators like interferons (IFNs) and Mycobacterium w (Mw) have also been repurposed. Considering the role of multiple cytokines implicated in COVID-19, molecules working on the majority of the targets, may hold a promising future prospect.
Rangappa P. Cytokine Storm and Immunomodulation in COVID-19. Indian J Crit Care Med 2021;25(11)1288-1291.
Rangappa P. Cytokine Storm and Immunomodulation in COVID-19. Indian J Crit Care Med 2021;25(11)1288-1291.COVID-19 is a multifaceted infectious disease. The development of hypoxemic respiratory failure is not uncommon during the course of illness in some of them. The objectives of the present study were to assess the effect of the addition of a surgical face mask while delivering oxygen via nasal cannula in hypoxemic COVID-19 patients and highlight on the advantages and patient's comforts. We prospectively assessed 30 consecutive conscious and hypoxemic COVID-19 patients, requiring oxygen via nasal cannula. The mean PaO2 without and with surgical face mask were 52 (+9) and 83 (-12) mm Hg respectively in the cohort, and the elevation in oxygen saturation was statistically significant (p
Senthilkumaran S, Koushik M, Meenakshisundaram R, Jena NN, Thirumalaikolundusubramanian P. Oxygen Administration under Surgical Face Mask in COVID-19 Patients A Game Changer. Indian J Crit Care Med 2021;25(11)1286-1287.
Senthilkumaran S, Koushik M, Meenakshisundaram R, Jena NN, Thirumalaikolundusubramanian P. Oxygen Administration under Surgical Face Mask in COVID-19 Patients A Game Changer. Indian J Crit Care Med 2021;25(11)1286-1287.
There is strong evidence for the use of corticosteroid in the management of severe coronavirus disease-2019 (COVID-19). However, there is still uncertainty about the timing of corticosteroids. We undertook a modified Delphi study to develop expert consensus statements on the early identification of a subset of patients from non-severe COVID-19 who may benefit from using corticosteroids.

A modified Delphi was conducted with two anonymous surveys between April 30, 2021, and May 3, 2021. An expert panel of 35 experts was selected and invited to participate through e-mail. The consensus was defined as >70% votes in multiple-choice questions (MCQ) on Likert-scale type statements, while strong consensus as >90% votes in MCQ or >50% votes for "very important" on Likert-scale questions in the final round.

Twenty experts completed two rounds of the survey. There was strong consensus for the increased work of breathing (95%), a positive six-minute walk test (90%), thorax computed tomography severity scorn the Use of Corticosteroids in Non-severe COVID-19. Indian J Crit Care Med 2021;25(11)1280-1285.
How to cite this article Nasa P, Chaudhry D, Govil D, Daga MK, Jain R, Chhallani AA, et al. Expert Consensus Statements on the Use of Corticosteroids in Non-severe COVID-19. Indian J Crit Care Med 2021;25(11)1280-1285.
The critical care unit is inherently stressful due to its complexity, leading to fatigue and consequences such as restless legs syndrome (RLS). This study aimed to investigate the prevalence of RLS and its relationship with fatigue in critical care nurses.

This cross-sectional study was performed with 200 nurses of critical care units of Shahroud hospitals in 2019 using the census sampling method. Data collection tools included the RLS questionnaire and the Multidimensional Fatigue Inventory. Data analysis was performed using descriptive and inferential statistics (multiple linear regression analysis).

The results showed that 72% of the subjects had moderate to high RLS, and their mean fatigue was 55.31 ± 10.53. By increasing one point in the score of RLS and 1 year of critical care nursing experience, the fatigue score increases by 0.3 and 0.71.

Considering the relationship between fatigue and RLS in critical care nurses, supportive interventions seem necessary to reduce the effects of these two components.
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