Ochrobactrum anthropi: An emerging pathogen causing meningitis with sepsis in a neurotrauma patient.

Ochrobactrum anthropi is an unusual emerging pathogen especially in the hospital environment.  Most of the reported cases are nosocomially acquired infections in patients with various indwelling and invasive medical devices, such as central venous catheters and drainage tubes. We report a case of nosocomially transmitted invasive catheter related septicaemia with meningitis due to O.

Aeromonas spp.: An Emerging Nosocomial Pathogen.

Aeromonads are hallophillic, nonacid fast, nonspore forming, Gram-negative rods which are widely distributed in the soil, foodstuffs, and aquatic environment. Since times immemorial, they are important zoonotic pathogens of poikilotherms but are now emerging as important human pathogens. These emerging enteric pathogens flourish in the water distribution system by forming biofilms.

Infections due to Elizabethkingia meningoseptica in critically injured trauma patients: a seven-year study.

Elizabethkingia meningoseptica is an infrequent cause of hospital-acquired infections. The clinical and microbiological profiles of infections due to E. meningoseptica over a seven-year period at a Level-I trauma centre are reported in this study.

Remaining unconscious: The burden of traumatic brain injuries in India.

Introduction: It is well-known that severe traumatic brain injuries (TBI) have a poor outcome. However, what is not well-known is the outcome for those who survive but remain unconscious at the time of discharge from the hospital.

Aims And Objectives: To assess the outcome of severe TBI patients who have a motor response of M5 or lower on the Glasgow coma score (GCS) at discharge from a single centre in India.

Head injury patient with bilateral vocal cord paralysis: a mistake and a lesson learnt.

Bilateral recurrent nerve palsy along with head injury is a rare clinical possibility and can be potentially fatal if not properly diagnosed. We report a case of a head injury patient with intact Glasgow Coma Scale requiring immediate re-intubation and tracheostomy after extubation failure as a result of stridor and severe dyspnoea with paradoxical respiratory pattern, possibly because of undiagnosed significant surgical history.

A well known and important adverse effect of phenytoin in a neurosurgical patient.

Gum hypertrophy is a well-known and important adverse effect of phenytoin therapy in a neurosurgical patient. We present an interesting case of a 21-year-old man who, following head injury after a road traffic accident, developed status epilepticus diagnosed with gum hypertrophy in the jaws, with ongoing antiepileptics. He was managed conservatively as per hospital protocol.

Should intensivist do routine abdominal ultrasound?

Roundworm infestation is common in tropical climate population with a low socioeconomic status. We describe a case of a young male with polytrauma accident who presented with small bowel dysfunction with a high gastric residual volume during enteral feeding. While searching the etiology, the intensivist performed bedside abdominal ultrasound (USG) as a part of whole body USG screening along with clinical examination using different frequency probes to examine bowel movement and ultimately found ascariasis to be the cause.

Diversity and antifungal resistance patterns of prevalent opportunistic pathogenic yeasts colonizing the oral cavities of asymptomatic human immunodeficiency virus-infected individuals, and their relation to CD4(+) counts.

Background: Yeasts are important opportunistic pathogens, in individuals infected with human immunodeficiency virus (HIV). Yeast species inhabiting the oral mucosa of HIV-infected persons can act as source of oral lesions, especially as the individual progresses towards immunocompromised state. Present study was conducted to evaluate the diversity of yeasts in oral cavities of asymptomatic HIV-infected persons and their association with CD4(+) cell counts.

Assessment of ultrasound as a diagnostic modality for detecting potentially unstable cervical spine fractures in pediatric severe traumatic brain injury: A feasibility study.

Background: Early cervical spine clearance is extremely important in unconscious trauma patients and may be difficult to achieve in emergency setting.

Objectives: The aim of this study was to assess the feasibility of standard portable ultrasound in detecting potentially unstable cervical spine injuries in severe traumatic brain injured (TBI) patients during initial resuscitation.

Materials And Methods: This retro-prospective pilot study carried out over 1-month period (June-July 2013) after approval from the institutional ethics committee.

Device-associated infections at a level-1 trauma centre of a developing nation: impact of automated surveillance, training and feedbacks.

Purpose: Device-associated infections constitute the majority of health care-associated infections (HAIs) in ICUs. Trauma patients are predisposed to acquire such infections due to various trauma-related factors. The prevalence of HAIs is underreported from developing nations due to a lack of systematic surveillance.

Emphysematous pancreatitis predisposed by Olanzapine.

A 32-year-old male presented to our intensive care unit with severe abdominal pain and was diagnosed as acute pancreatitis after 2 months of olanzapine therapy for bipolar disorder. His serum lipase was 900 u/L, serum triglyceride 560 mg/dL, and blood sugar, fasting and postprandial were 230 and 478 mg/dL, respectively on admission. Contrast enhanced computed tomography (CECT) of abdomen was suggestive of acute pancreatitis.

A unique anesthesia approach for carotid endarterectomy: Combination of general and regional anesthesia.

Carotid endarterectomy (CEA), a preventable surgery, reduces the future risks of cerebrovascular stroWke in patients with marked carotid stenosis. Peri-operative management of such patients is challenging due to associated major co-morbidities and high incidence of peri-operative stroke and myocardial infarction. Both general anesthesia (GA) and local regional anesthesia (LRA) can be used with their pros and cons.

Antibiotic susceptibilities, streptococcal pyrogenic exotoxin gene profiles among clinical isolates of group C or G Streptococcus dysgalactiae subsp. equisimilis & of group G S. anginosus group at a tertiary care centre.

Background & Objectives: Group C and group G streptococci (together GCGS) are often regarded as commensal bacteria and their role in streptococcal disease burden is under-recognized. While reports of recovery of GCGS from normally sterile body sites are increasing, their resistance to macrolides, fluoroquinolone further warrants all invasive β haemolytic streptococci to be identified to the species level and accurately tested for antimicrobial susceptibility. This study was aimed to determine the prevalence, clinical profile, antimicrobial susceptibility and streptococcal pyrogenic exotoxin gene profile (speA, speB, speC, speF, smeZ, speI, speM, speG, speH and ssa) of GCGS obtained over a period of two years at a tertiary care centre from north India.

Unusual late neurological complication in a child after an Indian krait bite.

Background: Neurological manifestations of elapid snakebites include neuromuscular paralysis and cerebrovascular complications. Autonomic manifestations are observed in almost two third of patients following moderate to severe envenomation.

Patient Summary: A 10-year-old boy presented with acute onset flaccid quadriparesis with encephalopathy, cranial neuropathy, and respiratory failure after bite of a common Indian krait.

Chest ultrasonography in emergency Cesarean delivery in multi-valvular heart disease with pulmonary edema during spinal anesthesia.

Valvular heart disease in a parturient presenting for Cesarean section is challenging. A 25 year old primigravida parturient with severe mitral stenosis, mild mitral regurgitation, mild aortic regurgitation, and mild pulmonary arterial hypertension required Cesarean delivery after developing pulmonary edema. Low-dose spinal with hyperbaric bupivacine 0.

Is abdomen release really necessary for prone ventilation in acute respiratory distress syndrome?

Prone ventilation for refractory acute respiratory distress syndrome (ARDS) mandates free abdomen by rolls in between chest wall and pelvic bones for better ventilation and control of airway pressure. We observed that, in patients with severe ARDS, prone ventilation with movable free abdomen produced high plateau pressure reduced by applying simple support to abdominal wall. Here, we have proposed a possible hypothesis to explain the paradoxical event in this particular group of patients.

Role of splenic artery embolization in management of traumatic splenic injuries: a prospective study.

The objective of our study was to evaluate the role of splenic artery embolization (SAE) in the management of traumatic splenic injuries. From September 2008 to September 2010, a total of 67 patients underwent nonoperative management (NOM) for blunt splenic injuries. Twenty-two patients were excluded from the study because of associated significant other organ injuries.

Giant retroperitoneal liposarcoma- renal salvage by autotransplantation.

Liposarcomas are the most common retroperitoneal soft tissue tumors. We here in report a case of giant retroperitoneal sarcoma which weighed 24 kgs. Renal autotransplant of right kidney was done for organ preservation.

How safe is the prone position in acute respiratory distress syndrome at late pregnancy?

We encountered a case of severe acute respiratory distress syndrome in late pregnancy due to influenza (H1N1) with refractory hypoxemia to conventional mechanical ventilation. Ventilation in prone position rescued this patient by maintaining oxygenation and sustaining improvement thereafter. Here, we discuss the mechanism of prone ventilation with special references to safety management of acute respiratory distress syndrome in the third trimester of pregnancy.