89 research outputs found
Hemolysis induced cross-matching difficulty with intravenous immunoglobulin: a case report
No full textAbstract Background Intravenous immunoglobulin is one of the most common modalities of treatment for Guillain–Barré syndrome. Although minor complications are easily preventable with pre-medications, rare complications like hemolysis occur at unexpected times and carry risks of repeated transfusions. A complication like difficulties in cross-matching blood is an uncommon event and is often not anticipated. We present one such rare case. Case presentation A 56-year-old man of Asian origin had presented to our hospital with rapidly progressive weakness of bilateral upper and lower limbs over 4 days. Guillain–Barré syndrome was diagnosed by nerve conduction velocity testing and lumbar puncture examination. On the third day of admission in hospital he was intubated because of respiratory failure. Intravenous immunoglobulin at 0.4 mg/kg per day for 5 days was planned and started. Our patient was scheduled for tracheostomy on a routine basis anticipating prolonged requirement of ventilator support. As the blood was being arranged, the blood bank facilities informed us about difficulties in cross-matching of the blood. Repeated samples and attempts at cross-matching were futile. After reviewing the available literature and diagnosing a case of hemolysis, relevant tests were performed and they were positive. Conclusions Anti-A and anti-B antibody present in intravenous immunoglobulin preparations sensitize the red blood cells to hemolysis and this occurrence is often incriminated as a cause of cross-matching and sometimes blood grouping difficulty. Although a high dose of intravenous immunoglobulin or repeated courses are often cited as reasons for hemolysis, individual variability in responses is common and it is not surprising to see one like we had in our case
Does early goal directed therapy in sepsis still hold relevance in low and middle-income countries?
No full textThe efficacy of early goal directed therapy in improving outcomes has been questioned in few recent studies. But, does that hold true for low and middle income countries like Nepal? This editorial expresses the views of the editors on the usual care of sepsis patients and early goal directed therapy in resource limited settings.</jats:p
Is chest X-ray in supine position for central lines confirmation a gold standard or a fallacy?
No full textEvaluation of the effect of gabapentin on postoperative analgesia with epidural morphine after abdominal hysterectomy
No full textBackground & Objectives: Gabapentin has been used successfully as a non-opioid analgesic adjuvant for postoperative pain management. We hypothesized that the preoperative use of gabapentin prolonged the analgesic effect of epidural morphine without an increase in adverse effects of morphine. Materials & Methods: In a randomized, double blind study sixty ASA PS I and II patients undergoing abdominal hysterectomy were assigned to receive either placebo or gabapentin 1200mg 1 hour before surgery. Postoperatively, 0.125% bupivacaine with morphine 50 µg per kg body weight was used for epidural analgesia. Vital parameters, time to the first request for analgesic, visual analogue scale scoring for pain at rest and during movement, 24-hour morphine consumption, and side effects were studied.Results: The patients were comparable with respect to age, weight, ASA PS, baseline hemodynamic parameters and duration of surgery. Gabapentin significantly decreased the duration of analgesia compared to placebo (1078.26 min Vs. 303.5 min; P value <0.0001). The VAS scores at rest and during movement at 1, 2, 4, 8, 12, and 24h were significantly lower in gabapentin group. The total amount of morphine consumption in 24 h postoperatively was significantly lower in gabapentin group (1.93mg Vs. 6.30mg; P value <0.0001). The incidence of nausea and pruritus was significantly lower with gabapentin. Conclusion: Oral gabapentin 1200 mg as a premedication decreases the dose requirement of epidural morphine and postoperative pain after total abdominal hysterectomy. It also decreases the pain scores at rest and during movement significantly. </p
Ascaris infestation leading to diarrhea and malnutrition
No full textGastrointestinal infestation with Ascaris lumbricoides is common in the tropical countries. A wide range of clinical presentations are reported for gastrintestinal ascariasis in both adults and children. We report a case of diarrhea causing malnutrition in ICU due to Ascaris infestation.Bangladesh Crit Care J March 2017; 5(1): 70-71</jats:p
Hard Knapsack Problems That Are Easy for Local Search
No full textChv'atal (1980) describes a class of zero-one knapsack problems provably difficult for branch and bound and dynamic programming algorithms. Chung et al. (1988) identifies a class of integer knapsack problems hard for branch and bound algorithms. We show that for both classes of problems local search provides optimal solutions quickly. Keywords : knapsack problem * local search * computational complexity Correspondence should be directed to the second author 1 Introduction Chv'atal (1980) describes a class of instances of zero-one knapsack problems due to Todd. ( We shall henceforth refer to these problems as the TODD class of problems. ) He shows that a wide class of algorithms --- including all based on branch and bound or dynamic programming --- find it difficult to solve problems in the TODD class. More precisely, the time required by these algorithms to solve instances of problems belonging to the TODD class grows as an exponential function of the problem parameters. Chung et a..
National ICU Registries as Enablers of Clinical Research and Quality Improvement
No full textOBJECTIVES:Clinical quality registries (CQRs) have been implemented worldwide by several medical specialties aiming to generate a better characterization of epidemiology, treatments, and outcomes of patients. National ICU registries were created almost 3 decades ago to improve the understanding of case-mix, resource use, and outcomes of critically ill patients. This narrative review describes the challenges, proposed solutions, and evidence generated by National ICU registries as facilitators for research and quality improvement.DATA SOURCES:English language articles were identified in PubMed using phrases related to ICU registries, CQRs, outcomes, and case-mix.STUDY SELECTION:Original research, review articles, letters, and commentaries, were considered.DATA EXTRACTION:Data from relevant literature were identified, reviewed, and integrated into a concise narrative review.DATA SYNTHESIS:CQRs have been implemented worldwide by several medical specialties aiming to generate a better characterization of epidemiology, treatments, and outcomes of patients. National ICU registries were created almost 3 decades ago to improve the understanding of case-mix, resource use, and outcomes of critically ill patients. The initial experience in European countries and in Oceania ensured that through locally generated data, ICUs could assess their performances by using risk-adjusted measures and compare their results through fair and validated benchmarking metrics with other ICUs contributing to the CQR. The accomplishment of these initiatives, coupled with the increasing adoption of information technology, resulted in a broad geographic expansion of CQRs as well as their use in quality improvement studies, clinical trials as well as international comparisons, and benchmarking for ICUs.CONCLUSIONS:ICU registries have provided increased knowledge of case-mix and outcomes of ICU patients based on real-world data and contributed to improve care delivery through quality improvement initiatives and trials. Recent increases in adoption of new technologies (i.e., cloud-based structures, artificial intelligence, machine learning) will ensure a broader and better use of data for epidemiology, healthcare policies, quality improvement, and clinical trials
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