ADMISSION FRAILTY SCORE AS A GOOD CLINICAL SUBSTITUTE OF SOFA SCORE TO PROGNOSTICATE POST-PERCUTANEOUS CORONARY INTERVENTION PATIENTS ON ADVANCED LIFE-SUPPORT.

Background: This study aimed to assess and compare the prognostic value of frailty score (FS), Sequential Organ Failure Assessment (SOFA) score, and additive of FS and SOFA score, at the time of admission to the coronary care unit (CCU), for the prediction of short-term poor prognosis in post-myocardial infarction (MI) patients, requiring advanced life-support.

Methods: A cohort of post-MI patients admitted to CCU. The FS and SOFA score were obtained at the time of CCU admission.

Steroids and myocardial infarction: Investigating safety and short-term mortality in critical post-myocardial infarction patients.

Background: Conventionally, in the pre-percutaneous intervention era, free wall rupture is reported to be a major concern for using steroids in myocardial infarction (MI) patients. Therefore, the aim of this study was to evaluate the safety of the use of steroids in critically ill post-MI patients in terms of hospital course and short-term (up to 180-day) mortality.

Methods: We included patients admitted to CCU diagnosed with MI, undergone revascularization, critically ill, and requiring mechanical ventilator (MV) support.

Mechanical ventilation in acute myocardial infarction: Outcomes from a prospective audit at a cardiovascular hospital in Pakistan.

Background: This clinical audit aims to evaluate the clinical data regarding the management and outcomes of acute myocardial infarction (AMI) patients requiring mechanical ventilator (MV) support, along with identifying factors associated with prolonged MV support and 180-day mortality.

Materials And Methods: In this study, we audited clinical data regarding management, in-hospital and short-term outcomes of adult patients with AMI required MV support. Patients with prolonged MV duration (>24h) and/or 180-day mortality were compared with their counterparts, and associated factors were identified.

Predicting Post-Extubation Respiratory Failure After Myocardial Infarction Using The Rapid Shallow Breathing Index And Lung Ultrasound Score.

Background: The Rapid Shallow Breathing Index (RSBI) has been hypothesized to have discriminating power for categorizing patients at higher risk of post-extubation respiratory failure (RF). Hence aim of this study was to determine the predictive value of RSBI for post-extubation RF in patients after acute myocardial infarction (AMI).

Methods: Consecutive, intubated patients admitted post-revascularization were included.

Role Of Lung Ultrasound During Weaning In Patient With Mitral Regurgitation Post Angioplasty.

Background: We hypothesize that a change in lung ultrasound score (LUS) can assist in the early diagnosis of weaning-induced respiratory failure (RF). The objective of this study was to determine the utility of LUS in weaning patients with mitral regurgitation (MR) from mechanical ventilation (MV).

Methods: This prospective observational study included patients with acute coronary syndrome (ACS) who required invasive MV after angiography/angioplasty.

Fluid Resuscitation In Cardiogenic Shock: An Assessment Of Responsiveness And Outcome.

Background: Fluid replacement for resuscitation in cardiogenic shock (CS) patients remains a point of debate in clinical practice. The purpose of the study was to assess the frequency of fluid responsiveness and outcomes of patients with cardiogenic shock receiving fluid resuscitation at the critical care unit (ICU) of a tertiary care cardiac center.

Methods: In this descriptive case series, in which all mechanically ventilated CS patients were evaluated who were assessed for fluid responsiveness by a fluid challenge.

Assessing the Utility of End-Tidal Carbon Dioxide as a Marker for Fluid Responsiveness in Cardiogenic Shock.

Background Preventing end-organ failure in patients with shock requires rapid and easily accessible measurements of fluid responsiveness. Unlike septic shock, not all patients in cardiogenic shock are preload responsive. We conducted this study to determine the discriminant power of changes in end-tidal carbon dioxide (ETCO), systolic blood pressure (SBP), inferior vena cava (IVC) collapsibility index (IVC-CI), and venous to arterial carbon dioxide (Pv-aCO) gap after a fluid challenge and compared it to increases in cardiac output.

Evaluating the Knowledge of Endotracheal Cuff Pressure Monitoring Among Critical Care Providers by Palpation of Pilot Balloon and By Endotracheal Tube Cuff Manometer.

Introduction Mishandled endotracheal cuff pressure may either make ventilation difficult or cause damage to the airway. Therefore, the aim of this audit was to assess the knowledge about endotracheal cuff pressure monitoring with a manometer and manual palpation of pilot balloon among critical care providers. Methods This audit includes 150 critical care providers having experience of handling endotracheal tube (ETT) cuff at critical care area of National Institute of Cardiovascular Diseases (NICVD), Karachi from April 2017 to June 2017.

Single Intramuscular Methylprednisolone dose in Asthma and Chronic Obstructive Pulmonary Disease Patients on Discharge.

Objective: In this pilot study we aimed to evaluate the safety of a single intramuscular methylprednisolone (IM) injection at the time of discharge as a replacement for oral steroid therapy for patients in our population with asthma or chronic obstructive pulmonary disease (COPD).

Methods: This proof-of-concept, open label clinical trial without randomisation was conducted at the Pulmonary Department of Ziauddin Hospital and University, Karachi from January 2018 to March 2018. Patients discharged after in-hospital treatment for exacerbations of either asthma or COPD were recruited for this study.

Prevalence of Obstructive Lung Disease in Asymptomatic Gas Field Workers.

Introduction Obstructive lung disease, if not managed appropriately and in a timely manner, increases morbidity and mortality. The aim of this study was to see an obstruction on spirometry reports of clinically asymptomatic oil and gas field workers. Methods In this retrospective observational study, spirometry reports performed at the pulmonary function laboratory of Ziauddin Hospital and University, Karachi, were reviewed.

Nasopharyngeal airway aspiration: An uncommon cause of sudden respiratory distress in hospitalized patients.

An elderly, bed ridden patient with a history of stroke was admitted for management of aspiration pneumonia. Two days after insertion of a nasopharyngeal airway, sudden respiratory distress prompted further investigations which led to the eventual diagnosis and removal of the nasopharyngeal airway that had been aspirated. The device was removed under conscious sedation with fiber optic bronchoscopy.

Unreported neurological complications of Gemella bergeriae infective endocarditis.

We report the first case of native aortic and mitral valve endocarditis due to Gemella bergeriae from the Middle East in a young patient with rheumatic heart disease. Our case illustrates a fulminant course of infection with G. bergeriae endocarditis that was complicated by embolic stroke, as well as intracerebral and subarachnoid haemorrhage secondary to rupture of a mycotic aneurysm in the right middle cerebral artery.

Acute peripheral polyneuropathy with multiorgan failure: a diagnostic dilemma.

We describe the case of a young man who presented with abdominal pain, vomiting and acute symmetric peripheral polyneuropathy. He was noted to have high anion gap metabolic acidosis with high lactate levels and persistently high arterial and venous pO2 values. The cerebrospinal fluid was acellular with a high protein and the nerve conduction study was consistent with axonal sensorimotor neuropathy.

Prophylactic use of laxative for constipation in critically ill patients.

Background: This study was designed to evaluate the use of laxative prophylaxis for constipation in intensive care unit (ICU) and the impact of early versus late bowel movement on patient's outcome.

Methods: The study was a prospective, randomized controlled trial in critically ill ventilated adult patients, who were expected to stay on ventilator for >72 h. Control group did not receive any intervention for bowel movement for the first 72 h, whereas interventional group received prophylactic dose of lactulose 20 cc enterally every 12 h for the first 72 h.

Comparison of quantitative bronchoscopic lavage cultures (B-BAL) with blind NG tube lavage (N-BAL) cultures in the diagnosis of ventilator associated pneumonia (VAP).

Objective: To compare quantitative Bronchoscopic Bronchoalveolar Lavage (B-BAL) cultures with blind nasogastric tube bronchoalveolar lavage (N-BAL) cultures in the diagnosis of Ventilator Associated Pneumonia (VAP).

Study Design: Cross-sectional comparative study.

Place And Duration Of Study: The study was conducted in Medical ICU and Chest ICU at Liaquat National Hospital (LNH), Karachi, from January till August, 2007.

"Moraxella lacunata" endocarditis treated with penicillin.

The case report of a young male with Endocarditis caused by Moraxella lacunata is presented. Although a well recognized cause of keratitis, conjunctivitis, and sinusitis; very few cases of endocarditis by this rare pathogen are reported in literature. Patient showed a prompt response when empirical therapy was de-escalated to penicillin, after receiving culture and sensitivity report from Microbiology department.

Catalytic hydrolysis of VIP in pregnant women with asthma.

Rationale: The neuropeptide vasoactive intestinal peptide (VIP) is one of the physiologic mediators of non-adrenergic, non-cholinergic smooth muscle relaxation of the airway and an important modulator of innate and adaptive immune responses. VIP catalytic autoantibodies are increased in asthma and serum VIP level is decreased during acute exacerbation of asthma. The effect of pregnancy on asthma is variable and depends in part on the severity of pre-existing asthma, along with other physiological and pathophysiological changes.

Use of thrombolytic therapy to treat heparin-refractory pulmonary embolism in a menstruating patient.

A 26-year-old woman developed an acute pulmonary embolism at the beginning of her menstrual cycle and was admitted to the hospital. When she failed initial standard treatment with heparin, the only other therapeutic option was a thrombolytic agent such as recombinant tissue plasma activator (rt-PA). Use of these agents, however, carries a large risk of major bleeding complications and brings concern of increased menstrual blood flow and duration.