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   Table of Contents - Current issue
Coverpage
July-September 2019
Volume 9 | Issue 3
Page Nos. 105-154

Online since Monday, September 30, 2019

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EDITORIAL  

What's new in critical illness and injury science? Antibiotics in critical care: Therapeutic toolbox Highly accessed article p. 105
Anisha Mathur
DOI:10.4103/IJCIIS.IJCIIS_81_19  
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EXPERT COMMENTARY Top

Infection prevention for open fractures: Is antibiotic monotherapy equivalent to multitherapy? p. 110
Andrew C Miller, Stanislaw P Stawicki
DOI:10.4103/IJCIIS.IJCIIS_79_19  
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REVIEW ARTICLE Top

Traumatic blunt cardiac injuries: An updated narrative review p. 113
Rayyan Fadel, Ayman El-Menyar, Samir ElKafrawy, Mohamad Gomaa Gad
DOI:10.4103/IJCIIS.IJCIIS_29_19  
Blunt cardiac injury (BCI) is defined as injuries sustained due to blunt trauma to the heart, and it remains unchanged for long time. The spectrum of BCI ranges from a minor “bruise” to specific postcontusion cardiac conditions such as free-wall rupture. This is a narrative review provides a continued and updates details regarding BCIs from 2008 to 2017. For this purpose, a narrative review of literature was conducted using appropriate database for retrieval of articles through systematic search methodology. Autopsy-based studies are very limited. It can be concluded that regardless of the variability in the spectrum of modalities and medical/surgical resources, BCIs diagnosis and management remain a puzzle and needs further prospective studies.
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ORIGINAL ARTICLES Top

Metabolic profile and prolactin serum levels in men with type 2 diabetes mellitus: Old-new rubric p. 120
Marwa S Al-Nami, Hayder M Al-Kuraishy, Ali I Al-Gareeb, Farah Al-Mamoori
DOI:10.4103/IJCIIS.IJCIIS_40_19  
Background: Prolactin (PRL) is involved in the regulation of glucose metabolism since high PRL serum levels are associated with low incidence of type 2 diabetes mellitus (T2DM). Therefore, the aim of the present study was to assess the metabolic effects of PRL on glucose homeostasis in men with T2DM. Methods: Eighty male patients with T2DM compared with 25 male healthy controls matched with patients for age and weight were divided into four groups: Group (A): patients with T2DM on metformin (n = 29), Group (B): patients with T2DM on glyburide (n = 30), Group (C): patients with T2DM on glyburide plus metformin (n = 21), and Group (D): healthy male subjects as control (n = 25). Body mass index (BMI) and blood pressure measurements were determined. Fasting blood glucose (FBG), glycated hemoglobin, total cholesterol, triglyceride (TG), high-density lipoprotein, low-density lipoprotein, atherogenic index, fasting serum insulin, insulin resistance (IR), and β-cell function of the pancreas were determined by homeostatic model assessment-2 (HOMA-IR). Furthermore, C-reactive protein and PRL serum level were determined in patients with T2DM and healthy control men. Results: BMI of T2DM patients was higher as compared with control (P = 0.003). Combination therapy (glyburide plus metformin) in patients with T2DM showed better effect on most of glycemic indices and lipid profile than glyburide or metformin monotherapy (P < 0.05). PRL serum level was higher in patients with T2DM as compared with control (P = 0.001). PRL serum level was high in glyburide-treated patients as compared with metformin-treated patients (P = 0.002). Conclusion: This study concludes that elevated PRL serum level in patients with T2DM is associated with diabetic complications. Diabetic pharmacotherapy mainly metformin reduced PRL serum level in patients with T2DM through amelioration of IR.
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Cefazolin and an aminoglycoside compared with cefazolin alone for the antimicrobial prophylaxis of type iii open orthopedic fractures p. 127
Shawn C Depcinski, Katherine H Nguyen, Peter T Ender
DOI:10.4103/IJCIIS.IJCIIS_7_19  
Context: Uncertainty of antibiotic prophylaxis of type III open orthopedic fractures still exists. Controversy remains as using cefazolin as a single agent or the addition of an aminoglycoside for broader coverage to prevent infection. Aims: The aim of the study was to determine if the combination of cefazolin and an aminoglycoside reduced infections compared with cefazolin alone. Subjects and Methods: This was a retrospective study inclusive of patients with type III open fracture admitted between January 1, 2010, and August 31, 2014 at a level 1 trauma center, who were prophylactically treated with cefazolin alone or cefazolin and an aminoglycoside. Statistical Analysis Used: All analyses were performed using Microsoft Excel 2010. Chi-square or Fisher's exact tests were used for categorical data and Wilcoxon rank-sum test for skewed continuous data. Logistic regression analysis was performed on all confounding variables with P < 0.1. Results: A significantly higher percentage in the combination group developed infection (6/15 [40%] vs. 8/53 [15.1%], P= 0.035). There was a trend toward a higher odds of infection in the combination group (odds ratio: 2.99, 95% confidence interval: 0.79–11.33, P= 0.107). Infection rates due to multidrug-resistant bacteria were statistically higher with the combination group (3/15 [20%] vs. 1/53 [1.9%], P= 0.046). There were no statistically significant differences in 30-day mortality, 1-year readmission rates due to fracture complication, or length of hospital stay. Conclusions: The results suggest that the addition of an aminoglycoside to cefazolin may not be necessary to prevent infection.
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Blood alcohol levels in road traffic accidents: Factors associated and the relationship between history of alcohol consumption and blood alcohol level detection p. 132
Kundavaram Paul Prabhakar Abhilash, Devraj Lath, J Kowshik, Arun Jose, Gina Maryann Chandy
DOI:10.4103/IJCIIS.IJCIIS_45_19  
Introduction: Alcohol consumption contributes to a significant number of road traffic accidents (RTAs), and data regarding the reliability of history and blood alcohol content (BAC) in RTA victims are scant. Methodology: This retrospective study was conducted in the emergency departments (EDs) over 6 weeks. All adult RTAs presenting within 12 h of the incident were included for analysis. Results: The study cohort included 369 RTA patients, with the mean interval before presentation being 3 h (standard deviation: 2.22). Two-wheeler accidents (77.2%) were the predominant mode of injury. Usage of a helmet and seat belt was documented in a meager (6.4% [17/267] and 8.8% [3/34], respectively). A positive history of alcohol consumption was reported by 19.5% of cases (72/369). However, BAC was detectable in 30.1% of cases (111/369), with an alarming 19.78% (73/369) being above the legal limit for driving. Nearly 77.5% (86/111) of those who tested positive for alcohol consumption were driving the vehicle involved. Positive BAC levels showed a significant association with young age (18–39 years), male gender, two-wheeler usage, and between 5 PM and 12 AM. Conclusion: A history of alcohol consumption leading to an RTA is not reliable in the ED. Hence, measuring BAC levels in all RTA patients provides an objective and reliable form of documentation for medico-legal purposes.
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Pharmacokinetic/pharmacodynamic predictions and clinical outcomes of patients with augmented renal clearance and Pseudomonas aeruginosa bacteremia and/or pneumonia treated with extended infusion cefepime versus extended infusion piperacillin/tazobactam p. 138
Anthony T Gerlach, Eric Wenzler, Lauren N Hunt, Jose A Bazan, Karri A Bauer
DOI:10.4103/IJCIIS.IJCIIS_70_18  
Aim: We sought to correlate pharmacokinetic (PK)/pharmacodynamic (PD) predictions of antibacterial efficacy and clinical outcomes in patients with augmented renal clearance (ARC) and Pseudomonas aeruginosa bacteremia or pneumonia treated with extended infusion cefepime or piperacillin/tazobactam. Materials and Methods: Cefepime (2 g every 8 h) and piperacillin/tazobactam (4.5 g every 8 h) were administered over 4 h after a loading dose infused over 30 min, and minimum inhibitory concentration was determined by E-test. Published population PK evaluations in critically ill patients were used, and PD analyses were conducted using estimated patient-specific PK parameters and known minimum inhibitory concentration values for P. aeruginosa. Concentration–time profiles were generated every 6 min using first-dose drug exposure estimates including a loading infusion, and free concentration above the minimum inhibitory concentration (f T> MIC) was estimated. Clinical cure was defined as resolution of signs and symptoms attributable to P. aeruginosa infection without need for escalation of antimicrobial. Results: One hundred and two patients were included (36 cefepime and 66 piperacillin/tazobactam). The two groups of patients had similar age, serum creatinine, weight, and creatinine clearance. The majority of patients required intensive care unit care (63.9% vs. 63.6%) and most had pneumonia (61%). The f T>MIC (93.6 [69.9–100] vs. 57.2 [47.6–72.4], P < 0.001) and clinical cure (91.7% vs. 74.2%, P= 0.039) were significantly higher in cefepime group, whereas mortality (8.3% vs. 22.7%, P= 0.1) and infection-related mortality (0% vs. 2%, P= 0.54) were similar. Conclusions: Patients with ARC and P. aeruginosa pneumonia and/or bacteremia who received extended-infusion cefepime achieved higher f T>MIC and clinical cure than those receiving extended infusion piperacillin/tazobactam.
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CASE REPORTS Top

Hypertensive crisis during spinal anesthesia due to undiagnosed pheochromocytoma p. 144
Paul Potnuru, Isabela C Saba, Brian M Osman
DOI:10.4103/IJCIIS.IJCIIS_82_18  
Undiagnosed pheochromocytoma poses significant intraoperative challenges to the anesthesiologist. These tumors generally cause profound hypotension after spinal anesthesia. We present an unusual case of a hypertensive crisis occurring in a patient under spinal anesthesia. Due to intraoperative hemodynamic instability, the case was converted to general anesthesia with a volatile anesthetic. Postoperative workup was consistent with a pheochromocytoma. Pheochromocytomas are rare, but given their significant intraoperative morbidity and mortality, they should be considered in the differential diagnosis of unexpected intraoperative hemodynamic changes.
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Kite-string injuries: A case series p. 147
Gaurav Muvalia, Nayer Jamshed, Tej Prakash Sinha, Sanjeev Bhoi
DOI:10.4103/IJCIIS.IJCIIS_44_19  
Kites are very popular in India. Over the years, both kite-flying and kite-making skills have evolved. The conventional cotton threads that were used as kite string (manja) have been replaced by much cheaper and stronger Chinese manja, which is based on nonbiodegradable synthetic fibers. It is hard to break and has caused a sudden surge in dangerous kite string-related injuries. There are a lot of injuries usually sustained by kite-flyers, two-wheeler riders, and pedestrians. Very few case reports and case series have shown injuries related to flying a kite, which range from laceration of hand to fatal throat injuries. Secondary impact injuries attributed to kite string (manja) are rarely reported in the medical literature. We present a series of four cases with special emphasis on a patient, who sustained secondary impact injury with fatal outcome. Emergency physician should know that these trivial looking injuries can be associated with significant neck injuries. They can also cause significant secondary impact injuries.
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CONFERENCE ABSTRACTS AND REPORTS Top

Summary of the first annual rocky mountain healthcare symposium p. 151
Megan Novak, Oliwier Dziadkowiec, Scott Strauss, Dianne McCallister, Michael S Firstenberg
DOI:10.4103/IJCIIS.IJCIIS_70_19  
The Medical Center of Aurora, in Aurora, Colorado (USA), served as the host institution for the First Annual Rocky Mountain Healthcare Symposium. The objectives of the Symposium were to offer a series of lectures, provided by a group of internationally recognized leaders in clinical medical research on “How to conduct clinical medical research,” and to allow medical residents from regional training programs to highlight their research. Twelve programs, from four US States, were represented. Oral presentations were given for selected abstracts with awards given for best posters and presentations. While the First Annual Symposium was generally viewed as successful based upon feedback metrics, survey results provided both subjective and quantitative foundation for improvements.
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