From Wallenberg’s to SIRS: A tale of a critically ill physician

Who knows more about a disease than the one who suffers it? That’s the repeated phrase that my anatomy teacher used to say everyday while I was a first-year medical student. At that time, it was just a phrase. It made me think that we only understand but suffering. And recently, that was the case.
From Wallenberg’s to SIRS- A tale of a critically ill physician


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A pre-printed medication chart in the ICU for patients admitted after coronary artery bypass graft surgery improves prescribing of secondary prevention at hospital discharge

Objective: To determine whether the introduction of a pre-printed Intensive Care Unit (ICU) drug chart after coronary artery bypass graft surgery (CABG) surgery was associated with an improvement in the rates of prescription of secondary prevention medicines at hospital discharge.
Design: Retrospective cohort study.
Setting: Tertiary cardiothoracic referral hospital in Wellington, New Zealand.
Patient and participants: Seven hundred forty-six CABG surgery patients. Three hundred seventy-one from the year before and 357 from the year after the introduction of the pre-printed ICU cardiac drug chart.
Interventions: A pre-printed ICU medication chart including aspirin, metoprolol, and atorvastatin used on all patients admitted to the ICU following CABG surgery.
Measurements: The primary outcome variable was the proportion of patients prescribed appropriate secondary prevention at hospital discharge. Secondary outcome variables included the proportion of patients receiving each of: aspirin, a beta-blocker, or a statin individually.
Results: Prescribing of appropriate secondary prevention increased from 81.1% to 92.7% following the introduction of the chart, adjusted OR 2.63 (1.53 to 4.50), p<0.001. The association between year of prescription and overall prescribing was mainly due to an increase in the prescription of beta-blockers. Conclusions: Introduction of a pre-printed ICU cardiac drug chart was associated with an increase in the rates of prescribing of secondary prevention on hospital discharge post-CABG surgery. A pre-printed medication chart in the ICU for patients admitted after coronary artery bypass graft surgery improves prescribing of secondary prevention at hospital discharge


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The transpulmonary pressure as an indicator of lung stress in the disorder of chest wall mechanics in pediatric acute lung injury: Study in pig model

Objectives: To determine the role of the end-inspiratory transpulmonary pressure as an indicator of the lung stress in the disorder of chest wall mechanics, in pig model.
Design: Experimental study.
Setting: Department of Surgery and Radiology, Veterinary Medicine, Bogor Agricultural Institute.
Subjects: Nine healthy mixed breed domestic piglets were divided into 2 groups: intervention/splinted chest wall (n=5) and control (n=4).
Intervention: This study had approval from Animal Care and Use Committee. The care and handling animal were accorded with National Institute of Health guideline. All of animals were anesthetized, muscle paralyzed and bronchial lavage with warm saline, in supine position. Both group were mechanically ventilated and underwent lung recruitment using incremental-decremental technique. Chest wall splinting was conducted in intervention group while the control group did not.
Measurement and Main Results: Transpulmonary pressures calculated after measure the esophageal pressure using esophageal catheters. The transpulmonary pressure in intervention group prior to (1.80±2.28 cmH2O) and after (11.00±5.83 cmH2O) recruitment maneuver, increased significantly compared with control group prior to (1.25±3.68 cmH2O) and after (3.25±1.18 cmH2O), with p value 0.04. The difference of mean end-inspiratory transpulmonary pressure (Ptp plateau) between intervention and control group was significant (p=0.05). ∆Ptp plateau values have strong correlation with the increasing of chest wall elastance (Ecw) in the intervention group (p=0.001, R2=0.8) and control group (p=0.007, r=0.7), as well as the correlation of ∆Ptp plateau with decreasing the lung compliance (Cl) (p=0.05, r=0.8). The strong correlation between ∆Ptp plateau and ∆Paw (p=0.001, r=0.7) in the intervention group showed the potency of the transpulmonary pressure to reflect the real lung distending pressure and the lung stress.
Conclusions: The measurement of end-inspiratory transpulmonary pressure is reliable as an indicator of lung stress in disorder of chest wall mechanics.


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Clinical improvement of multiple sclerosis after implementation of mild therapeutic hypothermia: A case report

Therapeutic hypothermia is the latest, revolutionary therapy, mostly used in intensive care units after out-of-hospital, and sometimes in-hospital, cardiac arrest due to its neuroprotective effect. This therapeutic intervention has also been used to improve neurological outcome after cerebrovascular accidents and other neurological catastrophes. Multiple sclerosis is one of the main diseases that cause neurological dysfunction in young adults due to its irreversible autonomic nervous system damage. Its main symptoms are tremors, sensory loss, weakness, ataxia and diplopia, and the progression of these end up disabling the patient permanently, sometimes even with the implementation of immunotherapy. We report a patient with a longstanding history of relapsing-remitting multiple sclerosis, with frequent attacks every 1-3 months, that underwent therapeutic hypothermia for 96 hours after in-hospital cardiac arrest; her neurological recovery was outstanding with no neurological deficits caused by the cardiac arrest, and surprisingly, when she was assessed months after the ischemic insult, it was found that she hadn't presented a relapse of multiple sclerosis since hypothermia was implemented.
Clinical improvement of multiple sclerosis after implementation of mild therapeutic hypothermia- A case report


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Uncommon presentations of choriocarcinoma

Choriocarcinoma is a rare disease in the young population. It uncommonly occurs after a normal full term pregnancy or in men. In the report, we presented two uncommon manifestations of choriocarcinoma. In the first case, a young woman developed choriocarcinoma metastasis after a normal full term pregnancy. She was treated with chemotherapy after the diagnosis and finally recovered. In the second case, a young man suffered from severe respiratory failure due to lung pathology and finally succumbed. The diagnosis of pulmonary choriocarcinoma could only be made after postmortem examination. Both cases illustrated atypical presentations of this malignant but curable disease.
Uncommon presentations of choriocarcinoma


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