Safety of prolonged prone ventilation in critically ill COVID-19 patients: A short report.

To share our observations regarding the safety of prolonged prone ventilation admitted to our intensive care unit with critical COVID-19 pneumonia and required prone ventilation because of severe ARDS. Since our observations were limited to assessing the safety of prolonged prone ventilation in critical COVID-19 patients and not to analyze any mortality benefit, we did not compare prolonged prone ventilation with standard invasive ventilation or standard duration of prone ventilation.

Management of mild to moderate COVID-19 during the second wave in India: A non-evidence-based approach.

The biggest public health catastrophe of this century-the SARS coronavirus-2, 2019 (COVID-19) pandemic has affected nearly all countries. Countries after countries were gripped by the intermittent waves of the infection. One of the most affected countries was India, wherein the second wave of the pandemic afflicted the vast swathe of the nation. The medical community was overwhelmed and stressed with the inordinate number of patients. Doctors were inundated with the task of managing all kinds of COVID-19 patients ranging from mildly symptomatic to critically ill, in addition to the non-COVID-19 patients. The life of most of the population was significantly disrupted due to the fear of infection and lockdowns in various places. Due to multiple reasons, physician access was limited for mild to moderately sick patients. During this time, online consultations were at their peak and many groups came forward to help Indian patients. These groups were supported largely by Indian doctors based overseas.

Autoimmune Hemolytic Anemia in Intensive Care Unit and Blood Transfusion: Lesson Learnt-A Case Report.

Clinicians are often in a difficult situation while managing severe anemia due to autoimmune hemolysis in intensive care unit (ICU). It is hard to get properly cross-matched blood due to the presence of autoantibody in the patient's serum. Still, such patients should not be devoid of transfusion. How to cite this article: Garg SK, Garg P. Autoimmune Hemolytic Anemia in Intensive Care Unit and Blood Transfusion: Lesson Learnt-A Case Report. Indian J Crit Care Med 2021;25(10):1201-1202.

Differential Diagnosis of Ketoacidosis in Hyperglycemic Alcoholic Diabetic Patient: Role of Insulin.

It is important to differentiate between diabetic ketoacidosis (DKA) and alcoholic ketoacidosis (AKA) in an alcoholic diabetic patient since it has significant management implications. Ketoacidosis in an alcoholic diabetic patient is a diagnostic challenge as both these clinical entities have metabolic acidosis with high anion gap. Most patients with DKA have hyperglycemia. The majority of AKA patients present with normal or low glucose levels; however, AKA may also present with high glucose levels, more so in diabetics. The situation becomes quite perplexing when an alcoholic diabetic patient presents with hyperglycemia since it can be attributed to DKA or AKA. How to cite this article: Garg SK, Garg P. Differential Diagnosis of Ketoacidosis in Hyperglycemic Alcoholic Diabetic Patient: Role of Insulin. Indian J Crit Care Med 2021; 25(10):1203-1204.

Pain Control and Opioid Use in ICU should be a Quality Parameter.

How to cite this article: Garg SK, Garg P. Pain Control and Opioid Use in ICU should be a Quality Parameter. Indian J Crit Care Med 2021; 25(10):1205-1206.

A comparative study of preoperative and postoperative changes in corneal astigmatism after pterygium excision by different techniques.

Purpose: To study the changes in corneal astigmatism before and after pterygium excision as well as with differences between various surgical techniques (bare sclera, conjunctival autograft, amniotic membrane graft). Methods: The study population included 71 patients with primary pterygium who underwent surgery. The surgical techniques used differed among the study population. All the patients were preoperatively assessed for visual acuity, anterior and posterior segments, autorefraction, and autokeratometry. After surgery, the patients were assessed for visual acuity, autorefraction, and autokeratometry on day 5, 1 month, and 3 months and the results were analyzed. Paired and unpaired t-tests were used to compare the variables. The probability level of 0.05 was considered as statistically significant. Results: The reduction in the mean preoperative astigmatism of 3.47 ± 1.74 Diopters (D) to 1.10 ± 0.78 D 3 months after surgery was statistically significant (P < 0.0001). Bare sclera, conjunctival autograft, and amniotic membrane graft techniques exhibited changes in astigmatism amounting to 1.85 ± 0.88 D, 2.55 ± 1.26 D, and 2.67 ± 1.44 D, respectively. Pterygium excision surgeries using amniotic membrane graft and conjunctival autograft techniques were more effective than pterygium excision surgery using bare sclera technique in reducing astigmatism. Conclusion: Pterygium excision results in significant reduction in astigmatism which leads to improvement in visual acuity. Amniotic membrane graft and conjunctival autograft are better surgical techniques than bare sclera as far as reducing astigmatism is concerned.

Is There Any Lower Limit of Serum Bicarbonate in Diabetic Ketoacidosis?

Diabetic ketoacidosis (DKA) is known as one of the most serious complications of diabetes and associated with significant morbidity and mortality. It consists of a triad of uncontrolled hyperglycemia, metabolic acidosis, and increased total body ketone concentration.1 It leads to high anion gap metabolic acidosis with fall in serum bicarbonate. HOW TO CITE THIS ARTICLE: Garg SK, Garg P. Is There Any Lower Limit of Serum Bicarbonate in Diabetic Ketoacidosis? IJCCM 2019; 23(11):542.

Is Ventilator-associated Pneumonia a Misnomer? Need to Rephrase it for Better Understanding.

How to cite this article: Garg SK, Garg P. Is Ventilator-associated Pneumonia a Misnomer? Need to Rephrase it for Better Understanding. Indian J Crit Care Med 2019;23(12):593.

An Interesting Presentation of Pheochromocytoma.

Pheochromocytoma is a rare cause of hypertension, but it could have severe consequences if not recognized and treated appropriately. Pheochromocytoma classically presents with paroxysms of hypertension and adrenergic symptoms including classic triad of episodic headache, sweating, and tachycardia. The clinical presentation of pheochromocytoma can mimic a number of other medical conditions including migraine, cardiac arrhythmias, myocardial infarction, and stroke, thus making the diagnosis of pheochromocytoma difficult, and treatment is directed toward presenting issue rather than underlying problem in such patients. We present a case of a 41-year-old male patient who presented with cerebellar infarct and found to have aortic thrombi and later developed acute myocardial infaction during same hospitalization. To the best of our knowledge, this is the first reported case of this kind.

Iatrogenic Bilateral Simultaneous Pneumothorax: Call for Vigilance.

Iatrogenic pneumothorax refers to the pneumothorax generated after diagnostic or therapeutic procedure. We report the case of a 40-year-old male who had bilateral simultaneous iatrogenic pneumothorax with pneumomediastinum leading to cardiac arrest situation, due to wrong placement of nebulization kit in spontaneously breathing intubated patient. We report this case for its rarity, due to the critical importance of this cause as a etiology of bilateral simultaneous iatrogenic pneumothorax leading to cardiac arrest situation, and need to understand the importance of continuous training and stress of emergency environment.